Active NPI
Jaimie Derosa, M.D.
- Facial Plastic Surgery Physician
- Boston, MA
National Provider Identifier
1023057031
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Facial Plastic Surgery Physician
- License
- 237016
- Practice address
- 91 Newbury St
Suite 300
Boston, MA 02116-3084 - Phone
- (617) 262-8000
- Fax
- (617) 262-8002
- NPI assigned
- Jun 5, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Facial Plastic Surgery Physician | 207YS0123X | 237016 | MA | Primary |
| Otolaryngology Physician | 207Y00000X | 237016 | MA |
Addresses
Primary practice location
91 Newbury St
Suite 300
Boston, MA 02116-3084
Mailing address
91 Newbury St
Suite 300
Boston, MA 02116-3084
Phone (617) 262-8000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2017 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 237016 | MA | MD | Otolaryngology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Geisinger Clinic | Past | Accepting new patients | |
| Massachusetts Eye and Ear Associates, Inc. | Otolaryngology | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Ophthalmology Physician
- Boston, MA
- NPI 1932574332
Otolaryngology
-
- Diagnostic Radiology Physician
- Danville, PA
- NPI 1558313023
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369353600000",
"number": "1023057031",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "91 NEWBURY ST",
"address_2": "SUITE 300",
"city": "BOSTON",
"state": "MA",
"postal_code": "021163084",
"telephone_number": "617-262-8000",
"fax_number": "617-262-8002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "91 NEWBURY ST",
"address_2": "SUITE 300",
"city": "BOSTON",
"state": "MA",
"postal_code": "021163084",
"telephone_number": "617-262-8000",
"fax_number": "617-262-8002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEROSA",
"first_name": "JAIMIE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-05",
"last_updated": "2013-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "207YS0123X",
"taxonomy_group": "",
"desc": "Otolaryngology, Facial Plastic Surgery",
"state": "MA",
"license": "237016",
"primary": true
},
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "MA",
"license": "237016",
"primary": false
}
],
"identifiers": [],
"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 May 24, 2013; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.