Individual provider Active NPI

Charae J. D'Ambra, N.P.

  • Pediatric Nurse Practitioner
  • Andover, MA
National Provider Identifier
1912199217
Registry record updated Oct 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
231679 Issued in MA
Practice address
323 Lowell St
Andover, MA 01810-4501
Phone
(978) 783-5000
Fax
(978) 313-8180
NPI assigned
Aug 10, 2007
Last updated
Oct 23, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 062444-23 NH
Pediatric Nurse Practitioner 363LP0200X 231679 MA Primary

Addresses

Primary practice location

323 Lowell St
Andover, MA 01810-4501

Mailing address

323 Lowell St
Andover, MA 01810-4501
Phone (978) 783-5000

Other identifiers 1

IdentifierTypeStateIssuer
30348060MedicaidNH

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
I20031114000500 MA Practitioner - Nurse Practitioner 4688588569 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
231679MAMDPediatric Nurse Practitioner
062444-23NHMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pentucket Medical Associates, LLC Current Accepting new patients
Bridgewater Pediatrics LLC Past Accepting new patients
Mass General Brigham Community Physicians Inc. PastSince Oct 16, 2022 Accepting new patients
Good Samaritan Medical Practice Corp Past Accepting new patients

Locations

500 Merrimack St
Lawrence, MA 01843
Phone (978) 557-8800

Interoperability endpoints

  • Direct secure messaging: dambra.charae.pma@direct.partners.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": "1186704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540252800000",
    "number": "1912199217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "323 LOWELL ST",
            "city": "ANDOVER",
            "state": "MA",
            "postal_code": "018104501",
            "telephone_number": "978-783-5000",
            "fax_number": "978-313-8180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 LOWELL ST",
            "city": "ANDOVER",
            "state": "MA",
            "postal_code": "018104501",
            "telephone_number": "978-783-5000",
            "fax_number": "978-313-8180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "D'AMBRA",
        "first_name": "CHARAE",
        "middle_name": "J.",
        "name_prefix": "Mrs.",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-10",
        "last_updated": "2018-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NH",
            "license": "062444-23",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MA",
            "license": "231679",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30348060",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Andover, MA

Sources for this page

Verify at the official NPI Registry.