Individual provider Active NPI

Lillian Johnson Juttukonda

  • Pediatrics Physician
  • Boston, MA
National Provider Identifier
1316406556
Registry record updated Jun 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
291558 Issued in MA
Practice address
840 Harrison Ave FL 4
Boston, MA 02118-2905
Phone
(617) 414-4511
NPI assigned
Mar 18, 2019
Last updated
Jun 23, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 291558 MA Primary

Addresses

Primary practice location

840 Harrison Ave FL 4
Boston, MA 02118-2905

Mailing address

960 Massachusetts Ave Ste 2
Boston, MA 02118-2690
Phone (617) 414-5405

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
I20250626001357 MA Practitioner - Pediatric Medicine 6204348915 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
291558MAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Boston Medical Center Corporation Current Accepting new patients
Child Health Foundation of Boston, Inc. Pediatrics CurrentSince Aug 1, 2025 Accepting new patients

Locations

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

850 Harrison Ave
#4
Boston, MA 02118
Phone (617) 414-2000

960 Massachusetts Ave
Ste 2
Boston, MA 02118
Phone (617) 414-7399

Interoperability endpoints

  • Direct secure messaging: ljuttukonda117900@direct.bmc.masshiway.net
  • Direct secure messaging: ljuttukonda252530@direct.bilh.masshiway.net
  • Direct secure messaging: ljuttukonda66417@direct.bostonchildrens.org

Organizations & group practices 2

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": "1552867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750636800000",
    "number": "1316406556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 MASSACHUSETTS AVE STE 2",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182690",
            "telephone_number": "617-414-5405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 HARRISON AVE FL 4",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182905",
            "telephone_number": "617-414-4511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUTTUKONDA",
        "first_name": "LILLIAN",
        "middle_name": "JOHNSON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-18",
        "last_updated": "2025-06-23",
        "certification_date": "2025-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "291558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.