NPIMap

Individual provider Active NPI

Edward Michael Dussom, MD

  • Surgery Physician
  • Brighton, MA
National Provider Identifier
1053805457
Registry record updated Jul 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
1016197 Issued in MA
Practice address
736 Cambridge St
Brighton, MA 02135-2907
Phone
(617) 789-3000
NPI assigned
Jun 19, 2018
Last updated
Jul 22, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 276408 MA
Surgery Physician 208600000X 1016197 MA Primary

Addresses

Primary practice location

736 Cambridge St
Brighton, MA 02135-2907

Mailing address

960 Massachusetts Avenue
FL 2
Boston, MA 02118-2690

Other practice location 1

725 Albany Street, Suite 3B
Shapiro Bldg.
Boston, MA 02118
Phone (617) 414-4861

Other identifiers 1

IdentifierTypeStateIssuer
110150184AMedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231226000946 MA Practitioner - General Surgery 3274887740 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Louisiana State University School of Medicine in New Orleans, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Boston University General Surgical Associates, Inc.Group PAC ID 9830183763, 86 clinicians
BMC Affiliated Physicians, Inc.Group PAC ID 9830133123, 543 clinicians

Practice addresses (Care Compare)

1 Boston Medical Ctr PL
Boston, MA 02118-2908
Phone (617) 638-8605

11 Nevins St
Brighton, MA 02135-3514
Phone (617) 779-6700

235 N Pearl St
Brockton, MA 02301-1794
Phone (508) 427-3000

732 Harrison Ave
Boston, MA 02118-2309

732 Harrison Ave FL 3
Preston BLDG
Boston, MA 02118-2309
Phone (617) 638-7350

736 Cambridge St
Brighton, MA 02135-2907
Phone (617) 789-3000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1016197MAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Boston University General Surgical Associates, Inc. Surgery CurrentSince Oct 8, 2025 Accepting new patients
BMC Affiliated Physicians, Inc. Surgery CurrentSince Apr 1, 2025 Accepting new patients
Steward Medical Group, Inc CurrentSince Nov 15, 2023 Accepting new patients
Boston University General Surgical Associates, Inc.-QMC CurrentSince Oct 8, 2025 Accepting new patients
Steward Medical Group, Inc CurrentSince Nov 15, 2023 Accepting new patients
Boston Medical Center Corporation Past Accepting new patients

Locations

732 Harrison Ave
Fl 5
Boston, MA 02118
Phone (617) 414-6840

960 Massachusetts Ave
Ste 2
Boston, MA 02118

11 Nevins St
Ste 201
Brighton, MA 02135
Phone (617) 789-2442

736 Cambridge St
Brighton, MA 02135
Phone (617) 789-2762

235 N Pearl St
Brockton, MA 02301
Phone (508) 427-2525

9 Galen St
Ste 155
Watertown, MA 02472
Phone (857) 304-2444

Interoperability endpoints

  • Direct secure messaging: edussom242458@direct.bmc.masshiway.net
  • Direct secure messaging: edward-michael.dussom.1@2017.direct.athenahealth.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1529366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753142400000",
    "number": "1053805457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 MASSACHUSETTS AVENUE",
            "address_2": "FL 2",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "736 CAMBRIDGE ST",
            "city": "BRIGHTON",
            "state": "MA",
            "postal_code": "021352907",
            "telephone_number": "617-789-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "725 Albany Street, Suite 3B",
            "address_2": "Shapiro Bldg.",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "02118",
            "country_code": "US",
            "telephone_number": "617-414-4861",
            "fax_number": "617-414-3617",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DUSSOM",
        "first_name": "EDWARD",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-19",
        "last_updated": "2025-07-22",
        "certification_date": "2025-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MA",
            "license": "276408",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MA",
            "license": "1016197",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110150184A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brighton, MA

Sources for this page

Verify at the official NPI Registry.