Dexter Dong, PMHNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · San Diego, CA
NPI 1144901844 · NPPES record last updated Jul 26, 2023
Key facts
- NPI
- 1144901844
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 95026283 (CA)
- Practice address
- 4077 Fifth Ave
San Diego, CA 92103-2105 - Phone
- (619) 686-3800
- NPI assigned
- Jul 26, 2023
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Cooley Dickinson Hospital Inc
Practice addresses (Care Compare)
30 Locust St
Northampton, MA 01060-2052
Phone (413) 582-2000
Hospital & facility affiliations
- Cooley Dickinson Hospital Inc,the
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240520002907 | MA | Practitioner - Nurse Practitioner | 7911349147 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95026283 | CA | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cooley Dickinson Hospital Inc | Current | Accepting new patients | |
| Hampshire Pathologists, Inc. | Current | Accepting new patients | |
| Cooley Dickinson Hospital Inc | Current |
Accepting new patients | |
| Cooley Dickinson Hospital Inc | Current |
Accepting new patients |
Locations
30 Locust St
Northampton, MA 01060
Phone (413) 582-2000
Interoperability endpoints
- dong.dexter.cdh@direct.partners.masshiway.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 95026283 | CA | Yes |
Addresses
Primary practice location
4077 Fifth Ave
San Diego, CA 92103-2105
Mailing address
4077 Fifth Ave
San Diego, CA 92103-2105
Other providers in San Diego, CA
- Shannon Donelan
- Nicole M Donelson
- Gina Dones
- Emma Doney
- Thomas Donez
- Henry W Dong
- Hoang Sy Dong
- Jessica Dong
- Kristin Dong
- Sydney Dong
All providers in San Diego, CA · Psychiatric/Mental Health Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 26, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.