NPIMap

Organization Active NPI

George H. Theodore, MD PC

  • Orthopaedic Foot and Ankle Surgery Physician
  • Boston, MA
National Provider Identifier
1215925888
Registry record updated Oct 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Foot and Ankle Surgery PhysicianTaxonomy code 207XX0004X
License
150940 Issued in MA
Legal business name
GEORGE H. THEODORE, MD PC
Practice address
175 Cambridge St
4TH Floor
Boston, MA 02114-2743
Phone
(617) 724-7009
Fax
(617) 643-1006
NPI assigned
Oct 7, 2005
Last updated
Oct 14, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2014

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

Authorized official

Name
George H Theodore, M.D.NPI 1639171101
Title
Owner
Phone
(617) 726-1344

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Foot and Ankle Surgery Physician 207XX0004X 150940 MA Primary

Addresses

Primary practice location

175 Cambridge St
4TH Floor
Boston, MA 02114-2743

Mailing address

175 Cambridge St
4TH Floor
Boston, MA 02114-2743
Phone (617) 724-7009

Other identifiers 4

IdentifierTypeStateIssuer
9730290MedicaidMA
727867OtherMATUFTS
M18225OtherMABCBS MA
173652OtherMAHPHC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050621000361 MA Part B Supplier - Clinic/Group Practice 4183669161 Receives reassigned benefits from 4 practitioners
Practice locations: Boston, MA

National Provider Directory

National Provider Directory

Locations

175 Cambridge St
Ste 400
Boston, MA 02114
Phone (617) 726-1344

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1128643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413244800000",
    "number": "1215925888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 CAMBRIDGE ST",
            "address_2": "4TH FLOOR",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142743",
            "telephone_number": "617-724-7009",
            "fax_number": "617-643-1006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 CAMBRIDGE ST",
            "address_2": "4TH FLOOR",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142743",
            "telephone_number": "617-724-7009",
            "fax_number": "617-643-1006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGE H. THEODORE, MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-07",
        "last_updated": "2014-10-14",
        "status": "A",
        "authorized_official_last_name": "THEODORE",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-726-1344",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207XX0004X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Foot and Ankle Surgery",
            "state": "MA",
            "license": "150940",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9730290",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "727867",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MA",
            "identifier": "M18225",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HPHC",
            "identifier": "173652",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.