Active NPI
Jay Rosamond Anderson, DMD
- General Practice Dentistry
- Bakersfield, CA
National Provider Identifier
1194070110
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 101391
- Practice address
- 1125 E California Ave
Bakersfield, CA 93307-1201 - Phone
- (661) 632-2144
- Fax
- (661) 328-4211
- NPI assigned
- Jul 16, 2012
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN1856087 | MA | |
| Dentist | 122300000X | DF0027 | OR | |
| Dentist | 122300000X | 4887 | KY | |
| General Practice Dentistry | 1223G0001X | 101391 | CA | Primary |
Addresses
Primary practice location
1125 E California Ave
Bakersfield, CA 93307-1201
Mailing address
P.O. Box 1559
Bakersfield, CA 93302
Phone (661) 635-3050
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PENDING | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151103001643 | OR | Order and Referring Only - Dentist | 9638489628 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 101391 | CA | MD | Social Worker |
| 4887 | KY | MD | Dentist |
| DN1856087 | MA | MD | Dentist |
| DF0027 | OR | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1342396800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1496361600000",
"number": "1194070110",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 1559",
"city": "BAKERSFIELD",
"state": "CA",
"postal_code": "93302",
"telephone_number": "661-635-3050",
"fax_number": "661-635-3070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1125 E CALIFORNIA AVE",
"city": "BAKERSFIELD",
"state": "CA",
"postal_code": "933071201",
"telephone_number": "661-632-2144",
"fax_number": "661-328-4211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "JAY",
"middle_name": "ROSAMOND",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-07-16",
"last_updated": "2017-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "DN1856087",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "DF0027",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "4887",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "101391",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PENDING",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bakersfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2017; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.