Individual provider Active NPI

Hallie Lucille Jefferson, MD

  • Pediatric Surgery Physician
  • Boston, MA
National Provider Identifier
1629799754
Registry record updated Mar 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Surgery PhysicianTaxonomy code 2086S0120X
License
295241 Issued in MA
Practice address
300 Longwood Ave # Baden273
Boston, MA 02115-5724
Phone
(617) 355-7932
NPI assigned
Sep 7, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 036173850 IL
Pediatric Surgery Physician 2086S0120X 295241 MA Primary

Addresses

Primary practice location

300 Longwood Ave # Baden273
Boston, MA 02115-5724

Mailing address

20 Charlesgate W Unit 620
Boston, MA 02215-2703

Other practice location 1

675 N Saint Clair St Ste 19-100
Chicago, IL 60611-5969
Phone (312) 664-3278

Other names 1

  • Lucy Jefferson Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20250407000907 IL Practitioner - Thoracic Surgery 8729502232 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Thoracic Surgery
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northwestern Medical Faculty FoundationGroup PAC ID 4587576814, 4,386 clinicians

Practice addresses (Care Compare)

675 N St Clair
100 Dept of Vasc Surgery
Chicago, IL 60611-5975
Phone (312) 695-2714

Hospital & facility affiliations

  • Northwestern Memorial Hospital Hospital, Chicago, IL, CCN 140281

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary artery bypass graft (CABG)13

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
295241MAMDPediatric Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Mar 1, 2025 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Mar 1, 2025 Accepting new patients
CHMC Cardiovascular Surgical Foundation Inc Thoracic Surgery (Cardiothoracic Vascular Surgery) PastSince Sep 11, 2022 Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

675 N Saint Clair St
Ste 19100
Chicago, IL 60611
Phone (312) 664-3278

675 N Saint Clair St
Ste 19-100
Chicago, IL 60611
Phone (312) 664-3278

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

515 Valley View Dr
Ste 201
Moline, IL 61265
Phone (312) 695-0870

Interoperability endpoints

  • Direct secure messaging: ljefferson28938@direct.bostonchildrens.org

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1662508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740960000000",
    "number": "1629799754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 CHARLESGATE W UNIT 620",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022152703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 LONGWOOD AVE # BADEN273",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021155724",
            "telephone_number": "617-355-7932"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "675 N Saint Clair St Ste 19-100",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606115969",
            "country_code": "US",
            "telephone_number": "312-664-3278",
            "fax_number": "312-695-2461",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JEFFERSON",
        "first_name": "HALLIE",
        "middle_name": "LUCILLE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-07",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "IL",
            "license": "036173850",
            "primary": false
        },
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "MA",
            "license": "295241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LUCY",
            "last_name": "JEFFERSON",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.