Active NPI
Dawit Tesfay Haile, MD
- Internal Medicine Physician
- Modesto, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- A195369
- Practice address
- 1700 Coffee Rd
Modesto, CA 95355-2803 - Phone
- (209) 526-4500
- NPI assigned
- May 28, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | MT220191 | PA | |
| Internal Medicine Physician | 207R00000X | A195369 | CA | Primary |
Addresses
Primary practice location
1700 Coffee Rd
Modesto, CA 95355-2803
Mailing address
3158 W Master St
Philadelphia, PA 19121-4423
Phone (202) 520-6532
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Hospitalist
- Education
- Other, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1700 Coffee Rd
Modesto, CA 95355-2803
Phone (209) 526-4500
600 Coffee Rd
Modesto, CA 95355-4201
Phone (209) 524-1211
Hospital & facility affiliations
- Memorial Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A195369 | CA | MD | Internal Medicine Physician |
| MT220191 | PA | MD | Student in an Organized Health Care Education/Training Program |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sutter Valley Medical Foundation | Internal Medicine | Current | Accepting new patients |
| Sutter Valley Medical Foundation | Internal Medicine | Current | Accepting new patients |
| Sutter Valley Medical Foundation | Current | Accepting new patients | |
| Sutter North Medical Foundation | Past | Accepting new patients |
Locations
2720 Low Ct
Fairfield, CA 94534
Phone (707) 428-2731
815 Court St
Ste 7
Jackson, CA 95642
Phone (209) 257-5900
600 Coffee Rd
Modesto, CA 95355
Phone (209) 550-4755
1700 Coffee Rd
Modesto, CA 95355
Phone (209) 526-4500
2800 L St
Ste 500
Sacramento, CA 95816
Phone (916) 454-6850
Interoperability endpoints
- dhaile2014470@direct.trinity-health.org
- dhaile692906@hisp.ehr.sutterhealth.org
Organizations & group practices 4
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.
-
- Multi-Specialty Clinic/Center
- Modesto, CA
- NPI 1669846986
Internal Medicine
-
- Multi-Specialty Clinic/Center
- Fairfield, CA
- NPI 1184859894
Internal Medicine
-
- Durable Medical Equipment & Medical Supplies
- Tracy, CA
- NPI 1720930712
-
- Ambulatory Surgical Clinic/Center
- Yuba City, CA
- NPI 1144251521
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Modesto, CA
- NPI 1699129601
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1590624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719360000000",
"number": "1124642889",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3158 W MASTER ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191214423",
"telephone_number": "202-520-6532"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1700 COFFEE RD",
"city": "MODESTO",
"state": "CA",
"postal_code": "953552803",
"telephone_number": "209-526-4500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAILE",
"first_name": "DAWIT",
"middle_name": "TESFAY",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-05-28",
"last_updated": "2024-06-26",
"certification_date": "2024-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "PA",
"license": "MT220191",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CA",
"license": "A195369",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.