NPIMap

Individual provider Active NPI

Beau Dicicco, M.D.

  • Dermatology Physician
  • New York, NY
National Provider Identifier
1255786000
Registry record updated Oct 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
304250 Issued in NY
Practice address
417 E 83Rd St Apt 5a
New York, NY 10028-6108
Phone
(512) 947-8926
NPI assigned
Apr 29, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 304250 NY Primary

Addresses

Primary practice location

417 E 83Rd St Apt 5a
New York, NY 10028-6108

Mailing address

1027 46TH Ave FL 3
Long Island City, NY 11101-5245
Phone (212) 385-3700

Other practice location 1

1901 1st Ave
New York, NY 10029-7404
Phone (212) 423-6262

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20200917002136 NY Practitioner - Dermatology 6901198472 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Texas Medical School at Houston, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bobby Buka, M.D., P.C.Group PAC ID 0547351140, 140 clinicians

Practice addresses (Care Compare)

220 Front St
New York, NY 10038-2033
Phone (212) 385-3700

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions271
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy131

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
304250NYMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Affiliate Group of New York PC CurrentSince Jan 20, 2026 Accepting new patients
Derm Specs of PA PLLC Dermatology CurrentSince Feb 25, 2024 Accepting new patients
Mount Sinai Hospital Past Accepting new patients
Out East Medical Dermatology PastSince Jun 15, 2021 Accepting new patients
Atlas Infectious Disease Practice PLLC Past Accepting new patients

Locations

1027 46th Ave
Fl 1
Long Island City, NY 11101

1027 46th Ave
Fl 3
Long Island City, NY 11101
Phone (212) 285-3700

1901 1st Ave
New York, NY 10029
Phone (212) 230-6262

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/22363/brand/1/csg/1/fhir/r4
  • Direct secure messaging: bdicicco305613@nychhc.direct-ci.com

Organizations & group practices 7

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

Hospital & facility affiliations 6

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": "1461888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761091200000",
    "number": "1255786000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1027 46TH AVE FL 3",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111015245",
            "telephone_number": "212-385-3700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 E 83RD ST APT 5A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100286108",
            "telephone_number": "512-947-8926"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1901 1st Ave",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100297404",
            "country_code": "US",
            "telephone_number": "212-423-6262",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICICCO",
        "first_name": "BEAU",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-29",
        "last_updated": "2025-10-22",
        "certification_date": "2025-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NY",
            "license": "304250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.