Kathleen Holly Gallivan, MD,MPH,FACS

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

204711 Issued in MA

Practice address

100 Tradecenter
Suite 750
Woburn, MA 01801-1851

Phone

(781) 937-3001

Fax

(781) 305-2779

NPI assigned

Jul 14, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kathleen Holly Dorr Other name

Medicare fee-for-service enrollment

Enrolled in MA, NH2 enrollments

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 2

Specialty

Otolaryngology

Education

Boston University School of Medicine, 1995

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Massachusetts Ear Nose and Throat Associates 3 LLCGroup PAC ID 0143623637, 2 clinicians

Massachusetts ENT Associates IncGroup PAC ID 6305891110, 20 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Winchester Hospital Hospital, Winchester, MA, CCN 220105
• Lowell General Hospital Hospital, Lowell, MA, CCN 220063
• Melrosewakefield Healthcare Hospital, Melrose, MA, CCN 220070
• Southern NH Medical Center Hospital, Nashua, NH, CCN 300020

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kgallivan46673@tuftsmedicine.direct-ci.com

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.

• Massachusetts Ear Nose and Throat Associates 3 LLC

  • Otolaryngology Physician
  • Woburn, MA
  • NPI 1548837032
  Medicare reassignment Care Compare group NPD
• Massachusetts ENT Associates Inc

  • Otolaryngology Physician
  • Chelmsford, MA
  • NPI 1063493492

  NH

  Medicare reassignment Care Compare group NPD
• Massachusetts Ear Nose and Throat Associates 4 LLC

  • Otolaryngology Physician
  • Woburn, MA
  • NPI 1710554217
  Medicare reassignment NPD
• Northridge Surgical Suites, LLC

  • Ambulatory Surgical Clinic/Center
  • Nashua, NH
  • NPI 1548822620
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Southern NH Medical Center

  • General Acute Care Hospital
  • Nashua, NH
  • NPI 1245447994
  Care Compare affiliation Name & address match
• Melrosewakefield Healthcare, Inc.

  • General Acute Care Hospital
  • Medford, MA
  • NPI 1841290467
  Care Compare affiliation
• The Lowell General Hospital

  • General Acute Care Hospital
  • Lowell, MA
  • NPI 1407804669
  Care Compare affiliation
• Winchester Hospital

  • General Acute Care Hospital
  • Winchester, MA
  • NPI 1790740777
  Care Compare affiliation

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

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393286400000",
    "number": "1427056225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 TRADECENTER",
            "address_2": "SUITE 750",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018011851",
            "telephone_number": "781-937-3001",
            "fax_number": "781-305-2779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 TRADECENTER",
            "address_2": "SUITE 750",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018011851",
            "telephone_number": "781-937-3001",
            "fax_number": "781-305-2779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLIVAN",
        "first_name": "KATHLEEN",
        "middle_name": "HOLLY",
        "credential": "MD,MPH,FACS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-14",
        "last_updated": "2014-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MA",
            "license": "204711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0109100",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHLEEN",
            "last_name": "DORR",
            "middle_name": "HOLLY",
            "credential": "MD, MPH, FACS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Raymond Gerard Gagnon, PT
• Grant Gahard
• Francesca I Galeon
• John P Gallagher Jr., LCSW
• Kara Lyn Gallagher
• Kelly M Galvin, NP
• Ghary Jed Gappelberg, M.D.
• Sandra G Garber, P.T.
• Kevin Daniel Garcia Lebron
• Tanairis Garcias Perez

• Otolaryngology Physician in Woburn, MA
• Providers in Woburn, MA by specialty
• Otolaryngology Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.