Boston Sports & Shoulder Center, LLC

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

BOSTON SPORTS & SHOULDER CENTER, LLC

Practice address

125 Parker Hill Ave
Boston, MA 02120-2847

Phone

(617) 264-1100

Fax

(617) 264-1101

NPI assigned

Mar 13, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Jonathan Shaker

Title

Executive Director

Phone

(781) 890-2133

Specialties & licenses 1

Addresses

Other names 1

• Boston Sports & Shoulder Center Doing business as

Tax ID family

Boston Sports Shoulder Centerllc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Boston Sports & Shoulder Center,LLC

  • Orthopaedic Surgery Physician
  • Dedham, MA
  • NPI 1619163052
  NPD tax ID

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

{
    "created_epoch": "1426204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709596800000",
    "number": "1972996098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 WINTER ST",
            "address_2": "ATTN: BOSTON SPORTS & SHOULDER CENTER",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024511433",
            "telephone_number": "781-890-2133",
            "fax_number": "781-890-2177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 PARKER HILL AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021202847",
            "telephone_number": "617-264-1100",
            "fax_number": "617-264-1101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSTON SPORTS & SHOULDER CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-13",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A",
        "authorized_official_last_name": "SHAKER",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "781-890-2133",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boston Sports & Shoulder Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Boston University

• Orthopaedic Surgery Physician in Boston, MA
• Providers in Boston, MA by specialty
• Orthopaedic Surgery Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2024; 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.