Individual provider Active NPI

Anne Marie Marie Dicredico

  • Adult Health Nurse Practitioner
  • Wakefield, MA
National Provider Identifier
1902411341
Registry record updated May 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
RN173023 Issued in MA
Practice address
888 Main St
Wakefield, MA 01880-4080
Phone
(781) 620-4890
NPI assigned
Sep 12, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X RN173023 MA Primary

Addresses

Primary practice location

888 Main St
Wakefield, MA 01880-4080

Mailing address

888 Main St
Wakefield, MA 01880-4080
Phone (781) 620-4890

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
I20210806001372 MA Practitioner - Nurse Practitioner 7517361991 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hallmark Health Medical Associates IncGroup PAC ID 4385638782, 151 clinicians

Practice addresses (Care Compare)

888 Main St
Wakefield, MA 01880-4080
Phone (781) 620-4888

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN173023MAMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Hallmark Health Medical Associates Inc Adult Health CurrentSince Jun 14, 2021 Accepting new patients

Locations

425 Revere St
Revere, MA 02151
Phone (781) 286-1313

888 Main St
Wakefield, MA 01880
Phone (781) 620-4888

Interoperability endpoints

  • Direct secure messaging: adicredico20700@tuftsmedicine.direct-ci.com

Organizations & group practices 1

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 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": "1599868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717113600000",
    "number": "1902411341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "888 MAIN ST",
            "city": "WAKEFIELD",
            "state": "MA",
            "postal_code": "018804080",
            "telephone_number": "781-620-4890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "888 MAIN ST",
            "city": "WAKEFIELD",
            "state": "MA",
            "postal_code": "018804080",
            "telephone_number": "781-620-4890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICREDICO",
        "first_name": "ANNE MARIE",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-12",
        "last_updated": "2024-05-31",
        "certification_date": "2024-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MA",
            "license": "RN173023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wakefield, MA

Sources for this page

Verify at the official NPI Registry.