Allysa Evelyn Chadderdon, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA4814 Issued in MA

Practice address

5 Branch St Ste 100
Methuen, MA 01844-1979

Phone

(978) 620-2020

Fax

(978) 620-2299

NPI assigned

Sep 5, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Allysa Jankowski Former name

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: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Beth Israel Deaconess Medical Center, Inc.

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1548202641
  Medicare reassignment NPD
• Dana-Farber Cancer Institute, Inc.

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1851333686
  Medicare reassignment NPD
• Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc

  • Internal Medicine Physician
  • Boston, MA
  • NPI 1194765438
  Medicare reassignment NPD
• Beth Israel Deaconess Medical Center, Inc.

  • Ambulance
  • Boston, MA
  • NPI 1518600501
  NPD
• Dana-Farber Cancer Institute, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Chestnut Hill, MA
  • NPI 1497429237
  NPD
• Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc

  • Emergency Medicine Physician
  • Boston, MA
  • NPI 1316987993
  NPD
• Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc

  • Dermatology Physician
  • Boston, MA
  • NPI 1043250616
  NPD (past)

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

{
    "created_epoch": "1346803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666310400000",
    "number": "1023367174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 BRANCH ST STE 100",
            "city": "METHUEN",
            "state": "MA",
            "postal_code": "018441979",
            "telephone_number": "978-620-2020",
            "fax_number": "978-620-2299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 BRANCH ST STE 100",
            "city": "METHUEN",
            "state": "MA",
            "postal_code": "018441979",
            "telephone_number": "978-620-2020",
            "fax_number": "978-620-2299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHADDERDON",
        "first_name": "ALLYSA",
        "middle_name": "EVELYN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-05",
        "last_updated": "2022-10-21",
        "certification_date": "2022-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA4814",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03497550",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALLYSA",
            "last_name": "JANKOWSKI",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Anjana Chakrabarti, MD
• Laurie L Charles, PH.D.
• Luyao Chen
• Mara-Hiley Chery, M.S., CCC-SLP

• Physician Assistant in Methuen, MA
• Providers in Methuen, MA by specialty
• Physician Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2022; 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.

Verify at the official NPI Registry.