NPIMap

Organization Active NPI

Boston Sports Medicine and Research Institute LLC

  • Specialist
  • Dedham, MA
National Provider Identifier
1972934529
Registry record updated May 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
152013 Issued in MA
Legal business name
BOSTON SPORTS MEDICINE AND RESEARCH INSTITUTE LLC
Practice address
40 Allied Dr
Dedham, MA 02026-6146
Phone
(617) 264-1100
Fax
(617) 264-1101
NPI assigned
Dec 9, 2013
Last updated
May 20, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2015

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

Authorized official

Name
Tom Gill, MD
Title
President
Phone
(617) 264-1100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 152013 MA Primary

Addresses

Primary practice location

40 Allied Dr
Dedham, MA 02026-6146

Mailing address

40 Allied Dr
Dedham, MA 02026-6146
Phone (617) 264-1100

Other identifiers 1

IdentifierTypeStateIssuer
11060187/AMedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140620000359 MA Part B Supplier - Clinic/Group Practice 6305060013 Receives reassigned benefits from 2 practitioners
Practice locations: Dedham, MA

National Provider Directory

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: gill.thomas.bsmri@direct.partners.masshiway.net
  • Direct secure messaging: petrone.brian.bsmri@direct.partners.masshiway.net

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1386547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432080000000",
    "number": "1972934529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 ALLIED DR",
            "city": "DEDHAM",
            "state": "MA",
            "postal_code": "020266146",
            "telephone_number": "617-264-1100",
            "fax_number": "617-264-1101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 ALLIED DR",
            "city": "DEDHAM",
            "state": "MA",
            "postal_code": "020266146",
            "telephone_number": "617-264-1100",
            "fax_number": "617-264-1101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSTON SPORTS MEDICINE AND RESEARCH INSTITUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-09",
        "last_updated": "2015-05-20",
        "status": "A",
        "authorized_official_last_name": "GILL",
        "authorized_official_first_name": "TOM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-264-1100",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MA",
            "license": "152013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11060187/A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dedham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.