Elizabeth Thidemann, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA100051 Issued in MA

Practice address

725 Concord Ave Ste 6100
Cambridge, MA 02138-1040

Phone

(617) 864-8822

Fax

(617) 491-4692

NPI assigned

Sep 21, 2022

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mount Auburn Professional Services IncGroup PAC ID 6103725031, 229 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Beth Israel Lahey Health at Home Home health agency, Beverly, MA, CCN 227495
• Mount Auburn Hospital Hospital, Cambridge, MA, CCN 220002

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/86/brand/1/csg/1/fhir/r4
• Direct secure messaging: ethidemann507241@direct.bilh.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.

• Mount Auburn Professional Services Inc

  • Internal Medicine Physician
  • Cambridge, MA
  • NPI 1992750996
  Medicare reassignment Care Compare group
• Mt Auburn Professional Services

  • Internal Medicine Physician
  • Cambridge, MA
  • NPI 1013375203
  NPD
• Mount Auburn Professional Services Inc

  • Internal Medicine Physician
  • Cambridge, MA
  • NPI 1255674636
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mount Auburn Hospital

  • General Acute Care Hospital
  • Cambridge, MA
  • NPI 1689670259
  Care Compare affiliation
• Northeast Professional Registry of Nurses Inc

  • Home Health Agency
  • Woburn, MA
  • NPI 1346257474
  Care Compare affiliation

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

{
    "created_epoch": "1663718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724889600000",
    "number": "1629791975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 MOUNT AUBURN ST # 2",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021385597",
            "telephone_number": "617-864-8822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 CONCORD AVE STE 6100",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021381040",
            "telephone_number": "617-864-8822",
            "fax_number": "617-491-4692"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "360 Huntington Avenue",
            "address_2": "202 Robinson Hall",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "02115",
            "country_code": "US",
            "telephone_number": "617-373-3195",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THIDEMANN",
        "first_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-21",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA100051",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MA",
            "license": "PA100051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Rita Thelen, LICSW
• Theodore P. Wasik, M.D.
• Ashley Stephanie Theodore
• Nathan Thibault, PHARMD
• Devon Thibodeau
• Alura Lindsey Thiem
• Thien Van Tran DMD LLC
• Anne Thomae, D.C.
• Thomas a Risser, MD PC
• Carrie A Thomas, CNM

• Medical Physician Assistant in Cambridge, MA
• Providers in Cambridge, MA by specialty
• Medical Physician Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.