NPIMap

Individual provider Active NPI

Christopher J Cannizzaro, PA-C

  • Physician Assistant
  • Brockton, MA
National Provider Identifier
1760778237
Registry record updated Mar 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA4196 Issued in MA
Practice address
235 N Pearl St
Brockton, MA 02301-1794
Phone
(508) 427-3000
NPI assigned
Jun 23, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2025

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 PA4196 MA Primary

Addresses

Primary practice location

235 N Pearl St
Brockton, MA 02301-1794

Mailing address

960 Massachusetts Ave Ste 2
Boston, MA 02118-2690
Phone (617) 414-5405

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110914000270 MA Practitioner - Physician Assistant 7517138050 Reassigns benefits to 8 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Shore Health Express IncGroup PAC ID 6406108836, 30 clinicians
BMC Affiliated Physicians, Inc.Group PAC ID 9830133123, 543 clinicians

Practice addresses (Care Compare)

106 New State Hwy
Raynham, MA 02767-5446
Phone (781) 280-1683

117 Old Church St
Pembroke, MA 02359-1969
Phone (781) 626-5170

170 Bedford St
Abington, MA 02351-2068
Phone (781) 626-5700

182 Summer St
Suite 1277
Kingston, MA 02364-1277
Phone (781) 626-5340

235 N Pearl St
Brockton, MA 02301-1794
Phone (508) 427-3000

330 Washington St
Weymouth, MA 02188-2932
Phone (781) 626-5160

59 Long Pond Rd
Plymouth, MA 02360-2670
Phone (781) 626-5180

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA4196MAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Compass Medical PC CurrentSince Sep 24, 2022 Accepting new patients
South Shore Health Express, Inc CurrentSince Jan 5, 2019 Accepting new patients
Baystate Wing Hospital Corporation CurrentSince Apr 20, 2016 Accepting new patients
Steward Medical Group, Inc Past Accepting new patients

Locations

1 Donalds Way
Ste 102
East Bridgewtr, MA 02333
Phone (508) 350-2100

40 Wright St
Palmer, MA 01069
Phone (413) 284-5210

117 Old Church St
Pembroke, MA 02359
Phone (781) 626-5170

54 Miller St
Ste 200
Quincy, MA 02169
Phone (617) 481-3200

85 South St
Ware, MA 01082
Phone (413) 967-2201

55 Fogg Rd
Weymouth, MA 02190
Phone (781) 340-4293

Interoperability endpoints

  • Direct secure messaging: ccannizzaro259795@direct.bmc.masshiway.net

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1308787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743120000000",
    "number": "1760778237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 MASSACHUSETTS AVE STE 2",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182690",
            "telephone_number": "617-414-5405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 N PEARL ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023011794",
            "telephone_number": "508-427-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNIZZARO",
        "first_name": "CHRISTOPHER",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-23",
        "last_updated": "2025-03-28",
        "certification_date": "2025-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA4196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

Verify at the official NPI Registry.