Individual provider Active NPI

Jamelah D Tucker, MD

  • Pediatrics Physician
  • Boston, MA
National Provider Identifier
1073711768
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
249948 Issued in MA
Practice address
800 Washington St #286
Floating Hospital for Children at Tufts Medical Center
Boston, MA 02111
Phone
(978) 788-7230
NPI assigned
Jul 5, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X D66354 MD
Pediatrics Physician 208000000X 249948 MA Primary
Pediatrics Physician 208000000X ME 107469 FL
Pediatrics Physician 208000000X 6712 AK

Addresses

Primary practice location

800 Washington St #286
Floating Hospital for Children at Tufts Medical Center
Boston, MA 02111

Mailing address

1835 E Hallandale Beach Blvd # 327
Hallandale Beach, FL 33009-4619
Phone (786) 530-7952

Other practice location 1

1117 E Hallandale Beach Blvd
Hallandale Beach, FL 33009-4488
Phone (954) 454-5131

Other identifiers 1

IdentifierTypeStateIssuer
412724200MedicaidMD

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120220000542 MA Practitioner - Pediatric Medicine 2466533971

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5316AKMDFamily Medicine Physician
6712AKMDPediatrics Physician
ME 107469FLMDPediatrics Physician
249948MAMDPediatrics Physician
D66354MDMDPediatrics Physician

NPI Registry JSON

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

{
    "created_epoch": "1183593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1073711768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1835 E HALLANDALE BEACH BLVD # 327",
            "city": "HALLANDALE BEACH",
            "state": "FL",
            "postal_code": "330094619",
            "telephone_number": "786-530-7952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 WASHINGTON ST #286",
            "address_2": "FLOATING HOSPITAL FOR CHILDREN AT TUFTS MEDICAL CENTER",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02111",
            "telephone_number": "978-788-7230"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1117 E Hallandale Beach Blvd",
            "address_purpose": "LOCATION",
            "city": "Hallandale Beach",
            "state": "FL",
            "postal_code": "330094488",
            "country_code": "US",
            "telephone_number": "954-454-5131",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "JAMELAH",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-05",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D66354",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "249948",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME 107469",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AK",
            "license": "6712",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "412724200",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.