NPIMap

Organization Active NPI

North Shore Ear, Nose & Throat Associates, PC

  • Otolaryngology Physician
  • Salem, MA
National Provider Identifier
1619940780
Registry record updated Jun 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
NORTH SHORE EAR, NOSE & THROAT ASSOCIATES, PC
Practice address
55 Highland Ave
Salem, MA 01970-2100
Phone
(978) 745-6601
Fax
(978) 744-4872
NPI assigned
Feb 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2008

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

Authorized official

Name
Charles J Leidner, MD
Title
President
Phone
(978) 745-6601

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X Primary

Addresses

Primary practice location

55 Highland Ave
Salem, MA 01970-2100

Mailing address

55 Highland Ave
Salem, MA 01970-2100
Phone (978) 745-6601

Other identifiers 6

IdentifierTypeStateIssuer
C14552OtherMARR MEDICARE GROUP NUMBER
34543OtherMAFALLON GROUP NUMBER
M13205OtherMABLUE SHIELD GROUP NUMBER
701493OtherMDTUFTS GROUP NUMBER
942871OtherMAAETNA GROUP NUMBER
9719032MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051116000507 MA Part B Supplier - Clinic/Group Practice 9032138367 Receives reassigned benefits from 22 practitioners
Practice locations: Beverly, MA; Danvers, MA

National Provider Directory

National Provider Directory

Locations

100 Cummings Ctr
Ste 136G
Beverly, MA 01915

100 Cummings Ctr
Beverly, MA 01915
Phone (978) 712-0003

100 Cummings Ctr
Ste 136
Beverly, MA 01915

104 Endicott St
Ste 102
Danvers, MA 01923

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212969600000",
    "number": "1619940780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 HIGHLAND AVE",
            "city": "SALEM",
            "state": "MA",
            "postal_code": "019702100",
            "telephone_number": "978-745-6601",
            "fax_number": "978-744-4872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 HIGHLAND AVE",
            "city": "SALEM",
            "state": "MA",
            "postal_code": "019702100",
            "telephone_number": "978-745-6601",
            "fax_number": "978-744-4872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE EAR, NOSE & THROAT ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-09",
        "last_updated": "2008-06-09",
        "status": "A",
        "authorized_official_last_name": "LEIDNER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "978-745-6601",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP NUMBER",
            "identifier": "C14552",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FALLON GROUP NUMBER",
            "identifier": "34543",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP NUMBER",
            "identifier": "M13205",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS GROUP NUMBER",
            "identifier": "701493",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA GROUP NUMBER",
            "identifier": "942871",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9719032",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.