Antoin Johnsen Deschrijver, PHYSICIAN ASSISTANT

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

500 Congress St
Suite 2H
Quincy, MA 02169

Phone

(617) 773-7431

Fax

(617) 773-7995

NPI assigned

Jun 4, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Associates of South Shore Dermatology LLCGroup PAC ID 2961623301, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Associates of South Shore Dermatology LLC

  • Dermatology Physician
  • Quincy, MA
  • NPI 1710387386
  Medicare reassignment Care Compare group
• Associates of South Shore Dermatology

  • Dermatology Physician
  • Quincy, MA
  • NPI 1942406210
  NPD (past)

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

{
    "created_epoch": "1370304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370304000000",
    "number": "1730527474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 CONGRESS ST",
            "address_2": "ASSOCIATES SOUTH SHORE DERMATOLOGY SUITE 2H",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "02169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 CONGRESS ST",
            "address_2": "SUITE 2H",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "02169",
            "telephone_number": "617-773-7431",
            "fax_number": "617-773-7995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESCHRIJVER",
        "first_name": "ANTOIN",
        "middle_name": "JOHNSEN",
        "name_prefix": "Mr.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-04",
        "last_updated": "2013-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dermcare Experts LLC
• Raffi Dersarkissian, MD
• Martin Kenneth Derusha, M.A.
• Ansh Yogesh Desai
• Taylor Desanty, LCSW
• Nyla Dessources
• Jennyfer Destin
• Melissa B Detillio
• Anne Elizabeth Detweiler, LICSW
• Alea Devaughn

• Student in an Organized Health Care Education/Training Program in Quincy, MA
• Providers in Quincy, MA by specialty
• Student in an Organized Health Care Education/Training Program in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2013; 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.