Individual provider Active NPI

Gideon Smith, MD PHD

  • Dermatology Physician
  • Boston, MA
National Provider Identifier
1649433152
Registry record updated Sep 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
247358 Issued in MA
Practice address
50 Staniford Street
Mass General Hospital Dermatology, Suite 800
Boston, MA 02114-2621
Phone
(617) 726-2914
NPI assigned
Jul 3, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 254990 NY
Dermatology Physician 207N00000X 247358 MA Primary

Addresses

Primary practice location

50 Staniford Street
Mass General Hospital Dermatology, Suite 800
Boston, MA 02114-2621

Mailing address

55 Fruit St
Dermatology Bar 622, Mass General Hospital
Boston, MA 02114-2621

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, VA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20111005000616 MA Practitioner - Dermatology 6103098629 Reassigns benefits to 2 organizations
I20250814004197 VA Practitioner - Dermatology 6103098629 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1950 Glenn Mitchell Dr
Suite 208
Virginia Beach, VA 23456-0168
Phone (757) 689-8139

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions96
Removal or shaving of skin growth1-10
Skin biopsy48

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
247358MAMDDermatology Physician
254990NYMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The General Hospital Corporation CurrentSince Oct 1, 2011 Accepting new patients
Evms Academic Physicians and Surgeons Health Services Foundation Dermatology CurrentSince Jul 1, 2025 Accepting new patients
Massachusetts General Physicians Organization Inc Dermatology CurrentSince Oct 1, 2011 Accepting new patients

Locations

55 Fruit St
#622
Boston, MA 02114
Phone (661) 275-6329

55 Fruit St
Boston, MA 02114

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

50 Staniford St
Ste 800
Boston, MA 02114

721 Fairfax Ave
Ste 200
Norfolk, VA 23507
Phone (757) 446-0593

600 Gresham Dr
Norfolk, VA 23507
Phone (757) 473-0055

1950 Glenn Mitchell Dr
Ste 208
Virginia Beach, VA 23456
Phone (757) 689-8139

Organizations & group practices 3

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.

Hospital & facility affiliations 2

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": "1215043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568764800000",
    "number": "1649433152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "address_2": "DERMATOLOGY BAR 622, MASS GENERAL HOSPITAL",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 STANIFORD STREET",
            "address_2": "MASS GENERAL HOSPITAL DERMATOLOGY, SUITE 800",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142621",
            "telephone_number": "617-726-2914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "GIDEON",
        "name_prefix": "Dr.",
        "credential": "MD PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-03",
        "last_updated": "2019-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NY",
            "license": "254990",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MA",
            "license": "247358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.