Individual provider Active NPI

Anissa Elizabeth Dickerson, CNM

  • Advanced Practice Midwife
  • Boston, MA
National Provider Identifier
1821351404
Registry record updated Nov 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
2278970 Issued in MA
Practice address
850 Harrison Ave
Yacc 5
Boston, MA 02118-4001
Phone
(617) 414-2080
Fax
(617) 414-2090
NPI assigned
Jun 19, 2012
Last updated
Nov 18, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X 2278970 MA Primary

Addresses

Primary practice location

850 Harrison Ave
Yacc 5
Boston, MA 02118-4001

Mailing address

720 Harrison Ave
Dob 503
Boston, MA 02118-2371

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120906000252 MA Practitioner - Certified Nurse Midwife (CNM) 4587811054 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Nurse Midwife (CNM)
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Atrius Health IncGroup PAC ID 4789588641, 1,214 clinicians

Practice addresses (Care Compare)

26 City Hall Mall
Medford, MA 02155-4754
Phone (781) 306-5100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
2278970MAMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Atrius Health, Inc. CurrentSince Oct 2, 2023 Accepting new patients
Neighborhealth Corporation CurrentSince Oct 9, 2017 Accepting new patients
Internal Medical Associates-Ebnhc CurrentSince Oct 9, 2017 Accepting new patients
Child Health Foundation of Boston, Inc. CurrentSince Feb 15, 2017 Accepting new patients
Atrius Health, Inc. CurrentSince Oct 2, 2023 Accepting new patients
Mount Auburn Hospital Past Accepting new patients

Locations

133 Brookline Ave
Boston, MA 02215
Phone (617) 421-1000

147 Milk St
Fl 9
Boston, MA 02109
Phone (617) 559-8051

75 Francis St
Boston, MA 02115

850 Harrison Ave
#4
Boston, MA 02118
Phone (617) 414-2000

10 Grove St
East Boston, MA 02128
Phone (617) 569-5800

26 City Hall Mall
Medford, MA 02155
Phone (781) 306-5100

720 Harrison Ave
#503
Roxbury, MA 02118
Phone 6174145404 ext. 2

Interoperability endpoints

  • Direct secure messaging: adickerson566860@direct.bilh.masshiway.net
  • Direct secure messaging: adickersoncnm374370@direct.atrius.masshiway.net

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1340064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479427200000",
    "number": "1821351404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 HARRISON AVE",
            "address_2": "DOB 503",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 HARRISON AVE",
            "address_2": "YACC 5",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021184001",
            "telephone_number": "617-414-2080",
            "fax_number": "617-414-2090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "ANISSA",
        "middle_name": "ELIZABETH",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-19",
        "last_updated": "2016-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "MA",
            "license": "2278970",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.