NPIMap

Organization Active NPI

Watertown Ear Nose and Throat GRP

  • Otolaryngology Physician
  • Watertown, NY
National Provider Identifier
1407948011
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
WATERTOWN EAR NOSE AND THROAT GRP
Practice address
826 Washington St
Suite 204
Watertown, NY 13601-4064
Phone
(315) 788-1751
Fax
(315) 788-9021
NPI assigned
Sep 29, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Braxton L Hillerman, MDNPI 1033105309
Title
President
Phone
(315) 788-1751

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
Otolaryngology Physician 207Y00000X Primary

Addresses

Primary practice location

826 Washington St
Suite 204
Watertown, NY 13601-4064

Mailing address

826 Washington St
Suite 204
Watertown, NY 13601-4064
Phone (315) 788-1751

Other identifiers 1

IdentifierTypeStateIssuer
00458053MedicaidNY

National Provider Directory

National Provider Directory

Locations

826 Washington St
Ste 204
Watertown, NY 13601
Phone (315) 788-1751

Practitioners & affiliated clinicians

Practitioners 7

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": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407948011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "826 WASHINGTON ST",
            "address_2": "SUITE 204",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136014064",
            "telephone_number": "315-788-1751",
            "fax_number": "315-788-9021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "826 WASHINGTON ST",
            "address_2": "SUITE 204",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136014064",
            "telephone_number": "315-788-1751",
            "fax_number": "315-788-9021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERTOWN EAR NOSE AND THROAT GRP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HILLERMAN",
        "authorized_official_first_name": "BRAXTON",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "315-788-1751",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00458053",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.