DR. EDWARD MICHAEL DUSSOM (MD) – Surgery Physician, NPI 1053805457
Surgery Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,028 GENERAL SURGERY in MA
Provider Addresses for DR. EDWARD MICHAEL DUSSOM (MD)
960 MASSACHUSETTS AVENUE
FL 2
BOSTON, MA 021182690
Phone:
Type: Mailing
725 Albany Street, Suite 3B
Shapiro Bldg.
Boston, MA 02118
Phone: (617) 414-4861
Fax: (617) 414-3617
Type: Location
St. Elizabeth's Medical Center, 736, Cambridge Street, Aberdeen, Brighton, Boston, Suffolk County, Massachusetts, 02135, United States
BRIGHTON, MA 021352907
Phone: (617) 789-2990
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2023-12-26
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20231226000946 | I | General Surgery | MA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 02118)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Emergency Medicine | MA | |
| Diagnostic Radiology | MA | |
| Anesthesiology, Pain Management | MA | |
| Physician Assistant | MA | |
| Internal Medicine, Infectious Disease | MA | |
| Physician Assistant | MA | |
| Hospitalist, Internal Medicine | MA | |
| Pulmonary Disease, Infectious Disease | MA | |
| Pulmonary Disease, Critical Care (Intensivists) | MA | |
| Physician Assistant | MA |
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