Provider Demographics
| NPI: | 1548344393 |
|---|---|
| Name: | CHILDREN'S ORTHOPAEDIC SURGERY FOUNDATION, INC. |
| Entity type: | Organization |
| Organization Name: | CHILDREN'S ORTHOPAEDIC SURGERY FOUNDATION, INC. |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CHIEF |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | MARTHA |
| Authorized Official - Middle Name: | M |
| Authorized Official - Last Name: | MURRAY |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MD |
| Authorized Official - Phone: | 617-355-6021 |
| Mailing Address - Street 1: | 300 LONGWOOD AVE |
| Mailing Address - Street 2: | |
| Mailing Address - City: | BOSTON |
| Mailing Address - State: | MA |
| Mailing Address - Zip Code: | 02115-5724 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 617-355-6021 |
| Mailing Address - Fax: | 617-730-0683 |
| Practice Address - Street 1: | 300 LONGWOOD AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | BOSTON |
| Practice Address - State: | MA |
| Practice Address - Zip Code: | 02115-5724 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 617-355-6021 |
| Practice Address - Fax: | 617-730-0683 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-10-25 |
| Last Update Date: | 2024-03-14 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 207XX0004X, 207XX0005X, 208000000X, 363LF0000X, 363LP0200X, 103TC0700X, 207PS0010X, 207X00000X, 207XS0106X, 207XP3100X | ||
| MA | 45761 | 207XX0801X, 207XS0117X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207XP3100X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Pediatric Orthopaedic Surgery | Group - Multi-Specialty |
| No | 207XX0004X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | Group - Multi-Specialty |
| No | 207XX0005X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | Group - Multi-Specialty |
| No | 207XX0801X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma | Group - Multi-Specialty |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
| No | 363LP0200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | Group - Multi-Specialty |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 207PS0010X | Allopathic & Osteopathic Physicians | Emergency Medicine | Sports Medicine | Group - Multi-Specialty |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 207XS0106X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | Group - Multi-Specialty |
| No | 207XS0117X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| VT | 1002821 | Medicaid | |
| 8014 | Other | FALLON COMMUNITY HEALTH P | |
| MA | 000000006554 | Other | BMC BOSTON HEALTH NET |
| MA | 0007614 | Other | NEIGHBORHOOD HEALTH PLAN |
| MA | 706324 | Other | TUFTS HEALTH PLAN |
| 8301420 | Other | AETNA COMMERCIAL | |
| MA | 9752765 | Medicaid | |
| NH | 30006161 | Medicaid | |
| PA | 0018942840001 | Medicaid | |
| RI | CO06968 | Medicaid | |
| 0029965 | Other | AETNA US HEALTHCARE | |
| NY | 02665332 | Medicaid | |
| ME | 150900000 | Medicaid | |
| MA | CMH14504 | Other | BLUE CROSS BLUE SHIELD MA |
| MA | 0007614 | Other | NEIGHBORHOOD HEALTH PLAN |
| 0029965 | Other | AETNA US HEALTHCARE | |
| 8301420 | Other | AETNA COMMERCIAL | |
| MA | ========= | Other | NETWORK HEALTH |
| MA | 9752765 | Medicaid | |
| VT | 1002821 | Medicaid |
