Antonio Jamaal Wideman, PEER SPECIALIST

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

202222 Issued in MA

Practice address

884 Cummins Hwy Apt 4
Mattapan, MA 02126-2043

Phone

(617) 691-6034

NPI assigned

Jul 28, 2022

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Connecting Human Rights Education LLC

  • Case Management Agency
  • Mattapan, MA
  • NPI 1447986740
  NPD Authorized official

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

{
    "created_epoch": "1658966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658966400000",
    "number": "1932835238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "884 CUMMINS HWY APT 4",
            "city": "MATTAPAN",
            "state": "MA",
            "postal_code": "021262043",
            "telephone_number": "617-691-6034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "884 CUMMINS HWY APT 4",
            "city": "MATTAPAN",
            "state": "MA",
            "postal_code": "021262043",
            "telephone_number": "617-691-6034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDEMAN",
        "first_name": "ANTONIO",
        "middle_name": "JAMAAL",
        "name_prefix": "Mr.",
        "credential": "PEER SPECIALIST",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-07-28",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Peer Specialist",
            "state": "MA",
            "license": "202222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Torleah A Washington
• Monique S White
• Whitworth Dental Assoc
• Cal B Whitworth, DC
• E Leo Whitworth Jr., DDS
• Stephanie M Williams, MUA
• Bernice Wong, MD
• Binglan Xue, DMD
• Cynthia Yu, DPT
• Samson Yu

• Peer Specialist in Mattapan, MA
• Providers in Mattapan, MA by specialty
• Peer Specialist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.