NPIMap

Organization Active NPI

Dermatology Institute of Boston PC

  • Dermatology Physician
  • Boston, MA
National Provider Identifier
1225407406
Registry record updated Sep 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
230993 Issued in MA
Legal business name
DERMATOLOGY INSTITUTE OF BOSTON PC
Practice address
441 Stuart St
4TH Floor Ste 404
Boston, MA 02116-5019
Phone
(857) 317-2057
Fax
(857) 317-2811
NPI assigned
Sep 17, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2015

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

Authorized official

Name
Dr. Emmy Graber, M.D.
Title
Owner
Phone
(857) 317-2057

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 230993 MA Primary

Addresses

Primary practice location

441 Stuart St
4TH Floor Ste 404
Boston, MA 02116-5019

Mailing address

441 Stuart St
4TH Floor Ste 404
Boston, MA 02116-5019
Phone (857) 317-2057

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151130001363 MA Part B Supplier - Clinic/Group Practice 7315247178 Receives reassigned benefits from 5 practitioners
Practice locations: Boston, MA

National Provider Directory

National Provider Directory

Locations

441 Stuart St
#404
Boston, MA 02116
Phone (857) 317-2057

441 Stuart St
Ste 4044
Boston, MA 02116

441 Stuart St
Ste 404
Boston, MA 02116
Phone (857) 317-2057

185 Dartmouth St
Ste 404
Boston, MA 02116
Phone (857) 317-2057

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1442448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443139200000",
    "number": "1225407406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "441 STUART ST",
            "address_2": "4TH FLOOR STE 404",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021165019",
            "telephone_number": "857-317-2057",
            "fax_number": "857-317-2811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "441 STUART ST",
            "address_2": "4TH FLOOR STE 404",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021165019",
            "telephone_number": "857-317-2057",
            "fax_number": "857-317-2811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY INSTITUTE OF BOSTON PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-17",
        "last_updated": "2015-09-25",
        "status": "A",
        "authorized_official_last_name": "GRABER",
        "authorized_official_first_name": "EMMY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "857-317-2057",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MA",
            "license": "230993",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2015; 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.