NPIMap

Individual provider Active NPI

Amanda Rachel Dickerson, MD

  • Pediatrics Physician
  • Northampton, MA
National Provider Identifier
1376741249
Registry record updated Dec 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
1015398 Issued in MA
Practice address
193 Locust St
Northampton, MA 01060-2056
Phone
(413) 517-2226
Fax
(413) 584-1714
NPI assigned
Jul 3, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2010021085 MO
Student in an Organized Health Care Education/Training Program 390200000X 2007017251 MO
Pediatrics Physician 208000000X 1015398 MA Primary

Addresses

Primary practice location

193 Locust St
Northampton, MA 01060-2056

Mailing address

193 Locust St
Northampton, MA 01060-2056
Phone (413) 517-2226

Other identifiers 5

IdentifierTypeStateIssuer
684702OtherANTHEM
200658010AMedicaidKS
1376741249MedicaidMO
A24058OtherHEALTH LINK
200295930AMedicaidOK

Other names 1

  • Dr. Amanda Rachel Webb Former name

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)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1015398MAMDSocial Worker
2010021085MOMDPediatrics Physician
2007017251MOMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Northampton Area Pediatrics, LLP Pediatrics PastSince Dec 3, 2023 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: adickerson37389@direct.chppoc.masshiway.net
  • Direct secure messaging: amanda.dickerson.1@20184.direct.athenahealth.com

Organizations & group practices 1

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": "1183420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701388800000",
    "number": "1376741249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "193 LOCUST ST",
            "city": "NORTHAMPTON",
            "state": "MA",
            "postal_code": "010602056",
            "telephone_number": "413-517-2226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "193 LOCUST ST",
            "city": "NORTHAMPTON",
            "state": "MA",
            "postal_code": "010602056",
            "telephone_number": "413-517-2226",
            "fax_number": "413-584-1714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "AMANDA",
        "middle_name": "RACHEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-03",
        "last_updated": "2023-12-01",
        "certification_date": "2023-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2010021085",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MO",
            "license": "2007017251",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "1015398",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "684702",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200658010A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1376741249",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH LINK",
            "identifier": "A24058",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200295930A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "WEBB",
            "middle_name": "RACHEL",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Northampton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2023; 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.