Active NPI
Jason Scully
- Massage Therapist
- Fairfield, CA
National Provider Identifier
1073111886
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 839445
- Practice address
- 871 Sunset CT
Fairfield, CA 94533-4145 - Phone
- (707) 971-6649
- NPI assigned
- Oct 14, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 839445 | CA | Primary |
Addresses
Primary practice location
871 Sunset CT
Fairfield, CA 94533-4145
Mailing address
871 Sunset CT
Fairfield, CA 94533-4145
Phone (707) 971-6648
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jasonscullycmt@protonmail.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 839445 | CA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1602633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602633600000",
"number": "1073111886",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "871 SUNSET CT",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945334145",
"telephone_number": "707-971-6648"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "871 SUNSET CT",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945334145",
"telephone_number": "707-971-6649"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCULLY",
"first_name": "JASON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-10-14",
"last_updated": "2020-10-14",
"certification_date": "2020-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "839445",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "jasonscullycmt@protonmail.com",
"affiliation": "N",
"endpointDescription": "Professional Email",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "871 Sunset Ct",
"city": "Fairfield",
"state": "CA",
"country_code": "US",
"postal_code": "945334145",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Fairfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.