Mark Wade Dickinson, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

230380 Issued in MA

Practice address

388 Commonwealth Ave
MGH Back Bay
Boston, MA 02215-2800

Phone

(617) 267-7171

Fax

(617) 262-2608

NPI assigned

Jul 21, 2005

Last updated

Aug 12, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 11

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

Specialty

Internal MedicineAlso: Pediatric Medicine

Education

University of California, San Diego School of Medicine, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mass General Brigham Medical Group, Inc.Group PAC ID 3971987108, 140 clinicians

Massachusetts General Physicians Organization IncGroup PAC ID 2466365820, 3,494 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Massachusetts General Hospital Hospital, Boston, MA, CCN 220071
• Brigham and Women Faulkner Hospital Hospital, Jamaica Plain, MA, CCN 220119
• Newton-Wellesley Hospital Hospital, Newton, MA, CCN 220101
• Brigham and Women's Hospital Hospital, Boston, MA, CCN 220110

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dickinson.mark.mgh@direct.partners.masshiway.net
• FHIR API: https://api.platform.athenahealth.com/958/brand/1/csg/1/fhir/r4

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.

• Massachusetts General Physicians Organization Inc

  • Dermatology Physician
  • Boston, MA
  • NPI 1801874573

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Mass General Brigham Medical Group, Inc.

  • Internal Medicine Physician
  • Salem, NH
  • NPI 1083360200

  MA

  Medicare reassignment Care Compare group NPD
• The General Hospital Corporation

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1023049236
  Medicare reassignment NPD
• General Hospital Corp

  dba Massachusetts General Hospital Outpatient Pharmacy

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1508390014
  NPD
• Brigham & Womens Hospital, Inc.

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1790717650
  NPD (past)
• Brigham and Women's Faulkner Hospital Inc

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1578677811
  NPD (past)
• Nashoba Valley Healthcare Group Inc

  • Family Medicine Physician
  • Ayer, MA
  • NPI 1174513071

  Internal Medicine

  NPD (past)
• Revere Medical of Massachusetts, PC

  • Internal Medicine Physician
  • Brockton, MA
  • NPI 1336976539
  NPD (past)
• El Centro Family Health

  • Federally Qualified Health Center (FQHC)
  • Wagon Mound, NM
  • NPI 1538324223
  NPD (past)
• El Centro Family Health

  • Federally Qualified Health Center (FQHC)
  • Espanola, NM
  • NPI 1780689034
  NPD (past)
• Monte Sol Medical Group

  • Internal Medicine Physician
  • Santa Fe, NM
  • NPI 1316964372
  NPD (past)

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

• Brigham & Womens Hospital, Inc.

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1790717650
  Care Compare affiliation
• Brigham and Women's Faulkner Hospital Inc

  • Psychiatric Hospital Unit
  • Boston, MA
  • NPI 1033121025
  Care Compare affiliation
• Brigham and Women's Faulkner Hospital Inc

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1578677811
  Care Compare affiliation
• Newton-Wellesley Hospital

  • General Acute Care Hospital
  • Newton, MA
  • NPI 1992737761
  Care Compare affiliation
• The General Hospital Corporation

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1023049236
  Care Compare affiliation

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

{
    "created_epoch": "1121904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250035200000",
    "number": "1154320059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "388 COMMONWEALTH AVE",
            "address_2": "MGH BACK BAY",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022152800",
            "telephone_number": "617-267-7171",
            "fax_number": "617-262-2608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "388 COMMONWEALTH AVE",
            "address_2": "MGH BACK BAY",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022152800",
            "telephone_number": "617-267-7171",
            "fax_number": "617-262-2608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKINSON",
        "first_name": "MARK",
        "middle_name": "WADE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-21",
        "last_updated": "2009-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "230380",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "230380",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MA",
            "license": "230380",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HPHC",
            "identifier": "AA77715",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MASSHEALTH",
            "identifier": "AA77715",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FALLON",
            "identifier": "121680",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2128071",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN GROUP 21240",
            "identifier": "OX2506",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "3975642",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "495561",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5035676",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NETWORK HEALTH",
            "identifier": "96009801",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "J41145",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN GROUP 21241",
            "identifier": "OX2507",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Savaughn Dickerson
• Shammika Reneara Dickerson
• Chandlee Camille Dickey, MD
• Sandra Ruth Dickie, FNP-BC
• Alexis Nicole Dickinson, NP
• William Bayne Dickinson, M.D.
• Madison Dickison
• Laura Dickman, LICSW
• Monica Lynn Dickmann, CRNA
• John Robert Dickson, M.D.,PH.D.

• Pediatrics Physician in Boston, MA
• Providers in Boston, MA by specialty
• Pediatrics Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2009; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.