NPIMap

Organization Active NPI

Hollistonpediatric Group

  • Pediatrics Physician
  • Holliston, MA
National Provider Identifier
1538184692
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
52479 Issued in MA
Legal business name
HOLLISTONPEDIATRIC GROUP
Practice address
100 Jeffrey Ave
Holliston, MA 01746-2028
Phone
(508) 478-5996
Fax
(508) 482-9147
NPI assigned
Jul 12, 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
Linda L Vaillette
Title
Practice Manager
Phone
(508) 478-5996

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 52479 MA Primary

Addresses

Primary practice location

100 Jeffrey Ave
Holliston, MA 01746-2028

Mailing address

100 Jeffrey Ave
Holliston, MA 01746
Phone (508) 478-5996

Other identifiers 3

IdentifierTypeStateIssuer
701376OtherMATUFTS HEALTH PLAN
M10882OtherMABLUE CROSS BLUE SHIELD
9749403MedicaidMA

National Provider Directory

National Provider Directory

Locations

100 Jeffrey Ave
Holliston, MA 01746
Phone (508) 429-2800

100 Jeffrey Ave
#2
Holliston, MA 01746

321 Fortune Blvd
Ste 202
Milford, MA 01757
Phone (603) 431-6703

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1538184692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 JEFFREY AVE",
            "city": "HOLLISTON",
            "state": "MA",
            "postal_code": "01746",
            "telephone_number": "508-478-5996",
            "fax_number": "508-482-9147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 JEFFREY AVE",
            "city": "HOLLISTON",
            "state": "MA",
            "postal_code": "017462028",
            "telephone_number": "508-478-5996",
            "fax_number": "508-482-9147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLLISTONPEDIATRIC GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VAILLETTE",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "508-478-5996"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "52479",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "701376",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "M10882",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9749403",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Holliston, MA

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.