Individual provider Active NPI

Michelle Dyrholm, DO

  • Anesthesiology Physician
  • Boston, MA
National Provider Identifier
1689106700
Registry record updated Apr 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
290864 Issued in MA
Practice address
55 Fruit Street
GRB 444
Boston, MA 02114-0211
Phone
(571) 814-8868
NPI assigned
Mar 29, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 274918 MA
Anesthesiology Physician 207L00000X A159217 CA
Anesthesiology Physician 207L00000X 290864 MA Primary

Addresses

Primary practice location

55 Fruit Street
GRB 444
Boston, MA 02114-0211

Mailing address

55 Fruit Street
GRB 444
Boston, MA 02114
Phone (571) 814-8868

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, 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
I20210825001776 CA Practitioner - Anesthesiology 0244501245 Reassigns benefits to 1 organization
I20220614000518 MA Practitioner - Anesthesiology 0244501245 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Arizona College of Osteopathic Medicine Mid Western University, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
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 Osteopathy

State licenses

LicenseStateTypeSpecialty
A159217CAMDAnesthesiology Physician
274918MAMDAnesthesiology Physician
18783CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Massachusetts General Physicians Organization Inc CurrentSince Jul 1, 2022 Accepting new patients
General Hospital Corp Current Accepting new patients
Regents of the University of California Anesthesiology CurrentSince Jul 18, 2021 Accepting new patients
Regents of the University of California CurrentSince Jul 18, 2021 Accepting new patients
The General Hospital Corporation CurrentSince Mar 4, 2022 Accepting new patients

Locations

200 W Arbor Dr
#7651
San Diego, CA 92103

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

55 Fruit St
Boston, MA 02114

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

55 Fruit St
#444
Boston, MA 02114
Phone (617) 319-3940

Interoperability endpoints

  • Direct secure messaging: dyrholm.michelle.mgh@direct.partners.masshiway.net

Organizations & group practices 5

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": "1490745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649376000000",
    "number": "1689106700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 FRUIT STREET",
            "address_2": "GRB 444",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02114",
            "telephone_number": "571-814-8868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT STREET",
            "address_2": "GRB 444",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021140211",
            "telephone_number": "571-814-8868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DYRHOLM",
        "first_name": "MICHELLE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-29",
        "last_updated": "2022-04-08",
        "certification_date": "2022-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MA",
            "license": "274918",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A159217",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MA",
            "license": "290864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.