Individual provider Active NPI

Jamie Waldron, M.D.

  • Allergy & Immunology Physician
  • Boston, MA
National Provider Identifier
1659714319
Registry record updated Apr 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
License
2017-01530 Issued in NC
Practice address
55 Fruit St
Boston, MA 02114-2696
Phone
(617) 726-7938
Fax
(617) 643-1274
NPI assigned
Apr 12, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 18, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy Physician 207KA0200X 2017-01530 NC
Allergy & Immunology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207K00000X 2017-01530 NC Primary
Allergy & Immunology (Internal Medicine) Physician 207RA0201X 2017-01530 NC

Addresses

Primary practice location

55 Fruit St
Boston, MA 02114-2696

Mailing address

4312 Waterford Valley Dr Apt 1338
Durham, NC 27713-8359
Phone (501) 772-4393

Other practice location 1

450 Macnider Hall Cb 7217
Chapel Hill, NC 27599-7101
Phone (919) 966-9675

Other practice location 2

4301 W Markham St
Little Rock, AR 72205-7101
Phone (501) 686-5356

Other identifiers 1

IdentifierTypeStateIssuer
1659714319MedicaidAR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jwaldron308600@direct.UNC.nchie.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, MA2 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
I20211102000377 NC Practitioner - Rheumatology 2163715046 Reassigns benefits to 1 organization
I20230503002619 MA Practitioner - Allergy/Immunology 2163715046 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Allergy/Immunology
Education
University of Arkansas College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

55 Fruit St
Boston, MA 02114-2696
Phone (617) 724-0287

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The General Hospital Corporation Single Specialty CurrentSince May 1, 2023 Accepting new patients
General Hospital Corp Current Accepting new patients
Massachusetts General Physicians Organization Inc Single Specialty CurrentSince May 1, 2023 Accepting new patients
University of North Carolina at Chapel Hill Single Specialty CurrentSince Sep 20, 2021 Accepting new patients

Locations

55 Fruit St
Boston, MA 02114

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

101 Manning Dr
Chapel Hill, NC 27514
Phone (984) 974-1485

Interoperability endpoints

  • Direct secure messaging: waldron.jamie.mgh@direct.partners.masshiway.net
  • Direct secure messaging: jwaldron308600@direct.unc.nchie.net

Organizations & group practices 4

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 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": "1365724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681776000000",
    "number": "1659714319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4312 WATERFORD VALLEY DR APT 1338",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277138359",
            "telephone_number": "501-772-4393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142696",
            "telephone_number": "617-726-7938",
            "fax_number": "617-643-1274"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "450 Macnider Hall Cb 7217",
            "address_purpose": "LOCATION",
            "city": "Chapel Hill",
            "state": "NC",
            "postal_code": "275997101",
            "country_code": "US",
            "telephone_number": "919-966-9675",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4301 W Markham St",
            "address_purpose": "LOCATION",
            "city": "Little Rock",
            "state": "AR",
            "postal_code": "722057101",
            "country_code": "US",
            "telephone_number": "501-686-5356",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALDRON",
        "first_name": "JAMIE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-04-12",
        "last_updated": "2023-04-18",
        "certification_date": "2023-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "NC",
            "license": "2017-01530",
            "primary": false
        },
        {
            "code": "207K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Allergy & Immunology",
            "state": "NC",
            "license": "2017-01530",
            "primary": true
        },
        {
            "code": "207RA0201X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Allergy & Immunology",
            "state": "NC",
            "license": "2017-01530",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1659714319",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jwaldron308600@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "101 Manning Dr",
            "city": "Chapel Hill",
            "state": "NC",
            "country_code": "US",
            "postal_code": "275144220",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.