NPIMap

Individual provider Active NPI

Tracy Dickerson, PA

  • Physician Assistant
  • Dorchester Center, MA
National Provider Identifier
1356570634
Registry record updated Apr 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
215 Issued in MA
Practice address
2100 Dorchester Ave
Dept. of Surgery
Dorchester Center, MA 02124-5615
Phone
(617) 296-4000
NPI assigned
Jul 8, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 215 MA Primary

Addresses

Primary practice location

2100 Dorchester Ave
Dept. of Surgery
Dorchester Center, MA 02124-5615

Mailing address

2100 Dorcester Ave
Dept. of Surgery
Dorcester, MA 02124
Phone (617) 296-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Steward Medical Group, Inc Past Accepting new patients
Caritas Medical Group, Inc. Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1247011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1271116800000",
    "number": "1356570634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 DORCESTER AVE",
            "address_2": "DEPT. OF SURGERY",
            "city": "DORCESTER",
            "state": "MA",
            "postal_code": "02124",
            "telephone_number": "617-296-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 DORCHESTER AVE",
            "address_2": "DEPT. OF SURGERY",
            "city": "DORCHESTER CENTER",
            "state": "MA",
            "postal_code": "021245615",
            "telephone_number": "617-296-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "TRACY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-08",
        "last_updated": "2010-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dorchester Center, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.