Individual provider Active NPI

Jeffrey M Soares, PA-C

  • Physician Assistant
  • Fall River, MA
National Provider Identifier
1366773202
Registry record updated Apr 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA3902 Issued in MA
Practice address
1030 President Ave Ste 307
Fall River, MA 02720-5928
Phone
(401) 751-7546
Fax
(401) 751-6888
NPI assigned
Jan 15, 2010
Last updated
Apr 24, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2026

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 PA3902 MA Primary

Addresses

Primary practice location

1030 President Ave Ste 307
Fall River, MA 02720-5928

Mailing address

1030 President Ave Ste 307
Fall River, MA 02720-5928

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100323000476 MA Practitioner - Physician Assistant 8123153608 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
May accept Medicare assignment
Group practices
Surgical and Cosmetic Dermatology of Rhode Island LLCGroup PAC ID 4183687205, 3 clinicians
Coastal Dermatology IncGroup PAC ID 3779860390, 10 clinicians

Practice addresses (Care Compare)

1030 President Ave
Fall River, MA 02720-5923
Phone (401) 751-7546

829 American Legion Hwy
Westport, MA 02790-4128
Phone (508) 306-1400

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Surgical & Cosmetic Dermatology of Rhode Island, LLC CurrentSince Nov 19, 2025 Accepting new patients
Dermatology Services ND PastSince Feb 14, 2021 Accepting new patients
Medical Affiliates of Cape Cod, Inc. Past Accepting new patients
Dermatology of Cape Cod, PC PastSince Oct 15, 2008 Accepting new patients
Plymouth Dermatology Specialists PLLC Physician Assistant PastSince Apr 13, 2025 Accepting new patients

Locations

1030 President Ave
Fall River, MA 02720
Phone (508) 235-6427

1030 President Ave
Ste 307
Fall River, MA 02720
Phone (401) 751-7546

1 Randall Sq
Ste 306
Providence, RI 02904
Phone (401) 751-7546

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/AFBBBA
  • Direct secure messaging: jsoares@dsiderm.emadirect.md

Organizations & group practices 9

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.

Hospital & facility affiliations 1

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": "1263513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776988800000",
    "number": "1366773202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 PRESIDENT AVE STE 307",
            "city": "FALL RIVER",
            "state": "MA",
            "postal_code": "027205928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 PRESIDENT AVE STE 307",
            "city": "FALL RIVER",
            "state": "MA",
            "postal_code": "027205928",
            "telephone_number": "401-751-7546",
            "fax_number": "401-751-6888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOARES",
        "first_name": "JEFFREY",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-01-15",
        "last_updated": "2026-04-24",
        "certification_date": "2026-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA3902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fall River, MA

Sources for this page

Verify at the official NPI Registry.