Active NPI
Shirley Gonzalez, MD
- Pediatrics Physician
- Watertown, MA
National Provider Identifier
1366438616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 153812
- Practice address
- 40 Spring St
Watertown, MA 02472-3444 - Phone
- (617) 926-0114
- Fax
- (617) 926-7052
- NPI assigned
- Sep 22, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 153812 | MA | Primary |
Addresses
Primary practice location
40 Spring St
Watertown, MA 02472-3444
Mailing address
40 Spring St
Watertown, MA 02472-3444
Phone (617) 926-0114
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3201180 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Newton Pediatrics LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Exclusive Provider Organization
- Chestnut Hill, MA
- NPI 1346552080
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127347200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1387238400000",
"number": "1366438616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40 SPRING ST",
"city": "WATERTOWN",
"state": "MA",
"postal_code": "024723444",
"telephone_number": "617-926-0114",
"fax_number": "617-926-7052"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 SPRING ST",
"city": "WATERTOWN",
"state": "MA",
"postal_code": "024723444",
"telephone_number": "617-926-0114",
"fax_number": "617-926-7052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALEZ",
"first_name": "SHIRLEY",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-22",
"last_updated": "2013-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MA",
"license": "153812",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3201180",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Watertown, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.