NPIMap

Organization Active NPI

Children'S Sports Medicine Foundation

  • Sports Medicine Podiatrist
  • Boston, MA
National Provider Identifier
1861680720
Registry record updated Oct 4, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine PodiatristTaxonomy code 213ES0000X
Legal business name
CHILDREN'S SPORTS MEDICINE FOUNDATION
Practice address
319 Longwood Ave
Boston, MA 02115-5728
Phone
(617) 355-5971
Fax
(617) 730-0178
NPI assigned
Oct 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2007

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

Authorized official

Name
Lyle J Micheli, M.D.
Title
Director
Phone
(617) 355-5971

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213ES0000X Primary

Addresses

Primary practice location

319 Longwood Ave
Boston, MA 02115-5728

Mailing address

PO Box 3694
Boston, MA 02241-3694
Phone (508) 946-1665

Other identifiers 2

IdentifierTypeStateIssuer
9782621MedicaidMA
M14628OtherMABCBS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191456000000",
    "number": "1861680720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3694",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022413694",
            "telephone_number": "508-946-1665",
            "fax_number": "508-947-1293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 LONGWOOD AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021155728",
            "telephone_number": "617-355-5971",
            "fax_number": "617-730-0178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S SPORTS MEDICINE FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-04",
        "last_updated": "2007-10-04",
        "status": "A",
        "authorized_official_last_name": "MICHELI",
        "authorized_official_first_name": "LYLE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "617-355-5971",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "213ES0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9782621",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "M14628",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2007; 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.