Active NPI
Matthew L Zizmor, DDS
- Prosthodontics
- Chestnut Hill, MA
National Provider Identifier
1952579724
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 13781
- Practice address
- 1244 Boylston St
Suite 205
Chestnut Hill, MA 02467-2116 - Phone
- (617) 738-4788
- NPI assigned
- Feb 14, 2008
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 13781 | MA | Primary |
Addresses
Primary practice location
1244 Boylston St
Suite 205
Chestnut Hill, MA 02467-2116
Mailing address
1244 Boylston St
Suite 205
Chestnut Hill, MA 02467-2116
Phone (617) 738-4788
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| X05193 | Other | MA | BLUE CROSS BLUE SHIELD |
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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150529000783 | MA | Order and Referring Only - Dentist | 5092035253 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13781 | MA | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404086400000",
"number": "1952579724",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1244 BOYLSTON ST",
"address_2": "SUITE 205",
"city": "CHESTNUT HILL",
"state": "MA",
"postal_code": "024672116",
"telephone_number": "617-738-4788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1244 BOYLSTON ST",
"address_2": "SUITE 205",
"city": "CHESTNUT HILL",
"state": "MA",
"postal_code": "024672116",
"telephone_number": "617-738-4788"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZIZMOR",
"first_name": "MATTHEW",
"middle_name": "L",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-02-14",
"last_updated": "2014-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "MA",
"license": "13781",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "X05193",
"state": "MA"
}
],
"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 Jun 30, 2014; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.