Individual provider Active NPI

Jill M Zalieckas, M.D.

  • Pediatric Surgery Physician
  • Boston, MA
National Provider Identifier
1174794556
Registry record updated Oct 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Surgery PhysicianTaxonomy code 2086S0120X
License
249191 Issued in MA
Practice address
300 Longwood Ave
Fegan 3
Boston, MA 02115-5724
Phone
(617) 355-1838
Fax
(617) 730-0477
NPI assigned
Mar 13, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Surgery Physician 2086S0120X 249191 MA Primary
Surgery Physician 208600000X 249191 MA

Addresses

Primary practice location

300 Longwood Ave
Fegan 3
Boston, MA 02115-5724

Mailing address

300 Longwood Ave
Fegan 3
Boston, MA 02115-5724
Phone (617) 355-1838

Other practice location 1

725 Albany Street
8C
Boston, MA 02118
Phone (617) 414-5131

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111108000747 MA Practitioner - Critical Care (Intensivists)Practitioner - General SurgeryPractitioner - Pediatric Medicine 0749453744 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
249191MAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
CHMC Surgical Foundation Inc Pediatric Surgery CurrentSince Jan 1, 2016 Accepting new patients
CHMC Anesthesia Foundation Inc Pediatric Surgery CurrentSince Nov 1, 2011 Accepting new patients
Childrens Hospital Boston Past Accepting new patients
Children's Hospital Corporation Past Accepting new patients

Locations

300 Longwood Ave
Boston, MA 02115
Phone (617) 355-4956

300 Longwood Ave
#3
Boston, MA 02115
Phone (617) 355-7737

Interoperability endpoints

  • Direct secure messaging: jzalieckas26720@direct.bostonchildrens.org

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1205366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635379200000",
    "number": "1174794556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 LONGWOOD AVE",
            "address_2": "FEGAN 3",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021155724",
            "telephone_number": "617-355-1838",
            "fax_number": "617-730-0477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 LONGWOOD AVE",
            "address_2": "FEGAN 3",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021155724",
            "telephone_number": "617-355-1838",
            "fax_number": "617-730-0477"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "725 Albany Street",
            "address_2": "8C",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "02118",
            "country_code": "US",
            "telephone_number": "617-414-5131",
            "fax_number": "617-414-3806",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZALIECKAS",
        "first_name": "JILL",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-13",
        "last_updated": "2021-10-28",
        "certification_date": "2021-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "MA",
            "license": "249191",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MA",
            "license": "249191",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.