Active NPI
Jon Hagenburg, DA
- Acupuncturist
- Providence, RI
National Provider Identifier
1114064433
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- DA00279
- Practice address
- 45 Eagle St
BLDG J, Unit 100
Providence, RI 02909-1011 - Phone
- (401) 323-2998
- NPI assigned
- Jan 30, 2007
- 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 |
|---|---|---|---|---|
| Acupuncturist | 171100000X | DA00279 | RI | Primary |
Addresses
Primary practice location
45 Eagle St
BLDG J, Unit 100
Providence, RI 02909-1011
Mailing address
45 Eagle St
BLDG J, Unit 100
Providence, RI 02909-1011
Phone (401) 323-2998
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 |
|---|---|---|---|
| DA00279 | RI | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114064433",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "45 EAGLE ST",
"address_2": "BLDG J, UNIT 100",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029091011",
"telephone_number": "401-323-2998"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "45 EAGLE ST",
"address_2": "BLDG J, UNIT 100",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029091011",
"telephone_number": "401-323-2998"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAGENBURG",
"first_name": "JON",
"name_prefix": "Dr.",
"credential": "DA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "RI",
"license": "DA00279",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.