Individual provider Active NPI

Jessica Van Lith

  • Physician Assistant
  • Boston, MA
National Provider Identifier
1689415630
Registry record updated Apr 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA102164 Issued in MA
Practice address
450 Brookline Ave
Boston, MA 02215-5450
Phone
(617) 632-3352
NPI assigned
Jun 4, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA102164 MA Primary

Addresses

Primary practice location

450 Brookline Ave
Boston, MA 02215-5450

Mailing address

450 Brookline Ave
Boston, MA 02215-5450
Phone (617) 632-3352

Other practice location 1

2730 S Moody Ave
Portland, OR 97201-5042
Phone (602) 819-9123

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20260109002620 MA Practitioner - Physician Assistant 4981180858 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Oregon Health Sciences University School of Medicine, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

450 Brookline Ave
Boston, MA 02215-5450

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PA102164MAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dana-Farber Cancer Institute, Inc. CurrentSince Jan 1, 2026 Accepting new patients
Dana-Farber Cancer Institute, Inc. CurrentSince Jan 1, 2026 Accepting new patients

Locations

450 Brookline Ave
Boston, MA 02215
Phone (508) 478-2061

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1717459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776729600000",
    "number": "1689415630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 BROOKLINE AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022155450",
            "telephone_number": "617-632-3352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 BROOKLINE AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022155450",
            "telephone_number": "617-632-3352"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2730 S Moody Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972015042",
            "country_code": "US",
            "telephone_number": "602-819-9123",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAN LITH",
        "first_name": "JESSICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-04",
        "last_updated": "2026-04-21",
        "certification_date": "2026-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA102164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.