Individual provider Active NPI

Stephen E Gellis, MD

  • Pediatric Dermatology Physician
  • Boston, MA
National Provider Identifier
1699873745
Registry record updated Aug 15, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Dermatology PhysicianTaxonomy code 207NP0225X
License
41583 Issued in MA
Practice address
300 Longwood Ave
Boston, MA 02115-5724
Phone
(617) 355-6117
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dermatology Physician 207NP0225X 41583 MA Primary
Pediatrics Physician 208000000X 41583 MA

Addresses

Primary practice location

300 Longwood Ave
Boston, MA 02115-5724

Mailing address

300 Longwood Ave
Boston, MA 02115-5724
Phone (617) 355-6117

Other identifiers 1

IdentifierTypeStateIssuer
2072020MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20040524000839 MA Practitioner - DermatologyPractitioner - Pediatric Medicine 5092706390 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
41583MAMDPediatric Dermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Hospital Pediatric Associates, Inc Pediatrics CurrentSince Dec 15, 2010 Accepting new patients
Childrens Hospital Boston Past Accepting new patients

Locations

85 Herrick St
Beverly, MA 01915
Phone (978) 816-3700

300 Longwood Ave
Ofc
Boston, MA 02115
Phone (617) 355-8083

300 Longwood Ave
Boston, MA 02115
Phone (617) 355-4956

482 Bedford St
Lexington, MA 02420
Phone (781) 528-2440

Interoperability endpoints

  • Direct secure messaging: sgellis25867@direct.bostonchildrens.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187136000000",
    "number": "1699873745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 LONGWOOD AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021155724",
            "telephone_number": "617-355-6117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 LONGWOOD AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021155724",
            "telephone_number": "617-355-6117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GELLIS",
        "first_name": "STEPHEN",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "MA",
            "license": "41583",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "41583",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2072020",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.