Active NPI
Matthew Gillman, MD
- Pediatrics Physician
- Boston, MA
National Provider Identifier
1912978461
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 54222
- Practice address
- 300 Longwood Ave
Boston, MA 02115-5724 - Phone
- (617) 355-6793
- NPI assigned
- Jan 31, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 54222 | MA | |
| Pediatrics Physician | 208000000X | 54222 | MA | Primary |
Addresses
Primary practice location
300 Longwood Ave
Boston, MA 02115-5724
Mailing address
PO Box 9135
Brookline, MA 02446-9135
Phone (800) 927-0002
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000033748 | Other | MA | BMC HEALTHNET |
| 3001385 | Medicaid | MA | |
| J04943 | Other | MA | BCBS MA |
| J04943 | Other | MA | BLUE CARE ELECT |
| J04943 | Other | MA | HMO BLUE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 54222 | MA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1263772800000",
"number": "1912978461",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9135",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024469135",
"telephone_number": "800-927-0002"
},
{
"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": "617-355-6793"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLMAN",
"first_name": "MATTHEW",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-31",
"last_updated": "2010-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MA",
"license": "54222",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MA",
"license": "54222",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BMC HEALTHNET",
"identifier": "000000033748",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3001385",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MA",
"identifier": "J04943",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CARE ELECT",
"identifier": "J04943",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HMO BLUE",
"identifier": "J04943",
"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 Jan 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.