NPIMap

Organization Active NPI

Adams Street Dermatology Assoc, PC

  • Dermatology Physician
  • Quincy, MA
National Provider Identifier
1164693289
Registry record updated Mar 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
81161 Issued in MA
Legal business name
ADAMS STREET DERMATOLOGY ASSOC, PC
Practice address
36 Adams St
Quincy, MA 02169-2002
Phone
(617) 773-9805
NPI assigned
Mar 17, 2008
Last updated
Mar 17, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2008

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

Authorized official

Name
Dr. Elise B McCarthy, MD
Title
President
Phone
(617) 773-9805

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 81161 MA Primary

Addresses

Primary practice location

36 Adams St
Quincy, MA 02169-2002

Mailing address

6 Adams Street
Quincy, MA 02169-2002
Phone (617) 773-9805

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080410000231 MA Part B Supplier - Clinic/Group Practice 0042397374 Receives reassigned benefits from 4 practitioners
Practice locations: Quincy, MA

National Provider Directory

National Provider Directory

Locations

36 Adams St
Quincy, MA 02169
Phone (617) 773-0711

6 Adams St
Quincy, MA 02169

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1205712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205712000000",
    "number": "1164693289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 ADAMS STREET",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021692002",
            "telephone_number": "617-773-9805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 ADAMS ST",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021692002",
            "telephone_number": "617-773-9805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADAMS STREET DERMATOLOGY ASSOC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-17",
        "last_updated": "2008-03-17",
        "status": "A",
        "authorized_official_last_name": "MCCARTHY",
        "authorized_official_first_name": "ELISE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-773-9805",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MA",
            "license": "81161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Quincy, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2008; 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.