NPIMap

Organization Active NPI

Massderm Billing PC

  • Dermatology Physician
  • Beverly, MA
National Provider Identifier
1033655667
Registry record updated Dec 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
242892 Issued in MA
Legal business name
MASSDERM BILLING PC
Practice address
900 Cummings Ctr
Suite 311-T
Beverly, MA 01915-6198
Phone
(978) 225-3376
NPI assigned
Jan 6, 2017
Last updated
Dec 7, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
MASSACHUSETTS DERMATOLOGY ASSOCIATES, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 7, 2021

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

Authorized official

Name
Dr. Jordan Cummins, M.D.NPI 1538297676
Title
President
Phone
(978) 225-3376

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 242892 MA Primary

Addresses

Primary practice location

900 Cummings Ctr
Suite 311-T
Beverly, MA 01915-6198

Mailing address

900 Cummings Ctr
Suite 311-T
Beverly, MA 01915-6198
Phone (978) 225-3376

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address derm@mda.emadirect.md Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200731000650 MA Part B Supplier - Clinic/Group Practice 2062837503 Receives reassigned benefits from 17 practitioners
Practice locations: Beverly, MA

National Provider Directory

National Provider Directory
Part of
Massachusetts Dermatology Associates PC

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1483660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638835200000",
    "number": "1033655667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 CUMMINGS CTR",
            "address_2": "SUITE 311-T",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019156198",
            "telephone_number": "978-225-3376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 CUMMINGS CTR",
            "address_2": "SUITE 311-T",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019156198",
            "telephone_number": "978-225-3376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASSDERM BILLING PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MASSACHUSETTS DERMATOLOGY ASSOCIATES, P.C.",
        "enumeration_date": "2017-01-06",
        "last_updated": "2021-12-07",
        "certification_date": "2021-12-07",
        "status": "A",
        "authorized_official_last_name": "CUMMINS",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "978-225-3376",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MA",
            "license": "242892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "derm@mda.emadirect.md",
            "affiliation": "N",
            "endpointDescription": "Secure direct mail to MassDerm Billing PC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "900 Cummings Ctr",
            "address_2": "Suite 311-T",
            "city": "Beverly",
            "state": "MA",
            "country_code": "US",
            "postal_code": "019156198",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Beverly, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2021; 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.