NPIMap

Individual provider Active NPI

Jordan Glicksman, MD

  • Otolaryngology Physician
  • Danvers, MA
National Provider Identifier
1124479282
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
270202 Issued in MA
Practice address
104 Endicott St Ste 100
Danvers, MA 01923-3623
Phone
(978) 745-6601
NPI assigned
Jun 29, 2016
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 270202 MA Primary

Addresses

Primary practice location

104 Endicott St Ste 100
Danvers, MA 01923-3623

Mailing address

104 Endicott St Ste 100
Danvers, MA 01923-3623
Phone (978) 745-6601

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, MA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160801000389 PA Practitioner - Otolaryngology 4183917982 Reassigns benefits to 1 organization
I20170725000786 MA Practitioner - Otolaryngology 4183917982 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New England Ear Nose and Throat LLCGroup PAC ID 7618125931, 11 clinicians

Practice addresses (Care Compare)

2000 Washington St
Mob White 544
Newton, MA 02462-1646
Phone (617) 910-0368

243 Charles St
Boston, MA 02114-3002
Phone (617) 523-7900

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
New England Ear Nose and Throat LLC Otolaryngology CurrentSince Dec 1, 2019 Accepting new patients
University of Penn-Medical Group Otolaryngology CurrentSince Jul 1, 2016 Accepting new patients
University of Penn-Medical Group Current Accepting new patients
North Shore Ear, Nose & Throat Associates Otolaryngology Current Accepting new patients
North Shore Ear, Nose & Throat Associates, PC Otolaryngology CurrentSince Jul 1, 2017 Accepting new patients
University of Penn-Medical Group CurrentSince Jul 1, 2016 Accepting new patients
Massachusetts Eye and Ear Associates, Inc. Otolaryngology CurrentSince Oct 1, 2017 Accepting new patients

Locations

133 Brookline Ave
Boston, MA 02215
Phone (617) 421-1000

243 Charles St
Boston, MA 02114
Phone (617) 523-7900

104 Endicott St
Ste 100
Danvers, MA 01923
Phone (978) 745-6601

104 Endicott St
Ste 102
Danvers, MA 01923

2000 Washington St
Ste 120
Newton Lower Falls, MA 02462
Phone (617) 969-0210

2000 Washington St
Ste 544
Newton Lower Falls, MA 02462
Phone (617) 910-0368

3624 Market St
Fl 2
Philadelphia, PA 19104
Phone (215) 615-3669

Interoperability endpoints

  • Direct secure messaging: glicksman.jordan.nsent@direct.partners.masshiway.net
  • Direct secure messaging: jglicksman88605@direct.bilh.masshiway.net

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1467158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1124479282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 ENDICOTT ST STE 100",
            "city": "DANVERS",
            "state": "MA",
            "postal_code": "019233623",
            "telephone_number": "978-745-6601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 ENDICOTT ST STE 100",
            "city": "DANVERS",
            "state": "MA",
            "postal_code": "019233623",
            "telephone_number": "978-745-6601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLICKSMAN",
        "first_name": "JORDAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-29",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MA",
            "license": "270202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Danvers, MA

Sources for this page

Verify at the official NPI Registry.