Azza H Idris, MD,PHD

Primary specialty

Pediatric Infectious Diseases PhysicianTaxonomy code 2080P0208X

License

282605 Issued in MA

Practice address

55 Fruit St
Boston, MA 02114-2621

Phone

(617) 726-8707

NPI assigned

Apr 24, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: idris.azza.mgh@direct.partners.masshiway.net

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.

• Massachusetts General Physicians Organization Inc

  • Dermatology Physician
  • Boston, MA
  • NPI 1801874573

  Pediatrics

  Medicare reassignment NPD
• The General Hospital Corporation

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1023049236
  Medicare reassignment NPD
• General Hospital Corp

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1508390014
  NPD
• Renee Haynesworth, MD

  • Pediatrics Physician
  • Ashburn, VA
  • NPI 1477658417
  NPD (past)

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704931200000",
    "number": "1437378718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142621",
            "telephone_number": "617-726-8707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142621",
            "telephone_number": "617-726-8707"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20608 Gordon Park Sq",
            "address_2": "Suite 170",
            "address_purpose": "LOCATION",
            "city": "Ashburn",
            "state": "VA",
            "postal_code": "201473141",
            "country_code": "US",
            "telephone_number": "703-858-2424",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IDRIS",
        "first_name": "AZZA",
        "middle_name": "H",
        "credential": "MD,PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-24",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101241618",
            "primary": false
        },
        {
            "code": "2080P0208X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Infectious Diseases",
            "state": "MA",
            "license": "282605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Idg Boston High Street Dental PC
• Idg Boston PO Square Dental PC
• Jared Thomas Iding, MD
• Samir Idjeri
• Randy Keegan Idler, MD
• Henrietta Imade Idumwonyi, BSN, RN
• Oghogho Joyce Idumwonyi
• Michael H. Ieong, M.D.
• Osahon Nelson Igbinoba, DMD,BDS
• Chidinma Lucky Igbokwe, ANP

• Pediatric Infectious Diseases Physician in Boston, MA
• Providers in Boston, MA by specialty
• Pediatric Infectious Diseases Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.