Active NPI
John Donald Otis Jr., PHD
- Clinical Psychologist
- Chestnut Hill, MA
National Provider Identifier
1659476125
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 8507
- Practice address
- 64 High Rock Ter
Chestnut Hill, MA 02467-2654 - Phone
- (617) 233-2625
- NPI assigned
- Sep 13, 2006
- Last updated
- Dec 21, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 8507 | MA | Primary |
Addresses
Primary practice location
64 High Rock Ter
Chestnut Hill, MA 02467-2654
Mailing address
64 High Rock Ter
Chestnut Hill, MA 02467-2654
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 1, 2018 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8507 | MA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703116800000",
"number": "1659476125",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "64 HIGH ROCK TER",
"city": "CHESTNUT HILL",
"state": "MA",
"postal_code": "024672654"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "64 HIGH ROCK TER",
"city": "CHESTNUT HILL",
"state": "MA",
"postal_code": "024672654",
"telephone_number": "617-233-2625"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTIS",
"first_name": "JOHN",
"middle_name": "DONALD",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-13",
"last_updated": "2023-12-21",
"certification_date": "2023-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "8507",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chestnut Hill, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2023; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.