Douglas L Jicha, MD

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

006810 Issued in ME

Practice address

306 US Route 1
BLDG C
Scarborough, ME 04074

Phone

(207) 885-5742

Fax

(207) 885-1494

NPI assigned

Jul 10, 2006

Last updated

Nov 3, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: djicha1657855@oc.providencedirect.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Providence Medical Foundation

  • Family Medicine Physician
  • Brea, CA
  • NPI 1871607762
  Medicare reassignment
• Providence Medical Foundation

  • General Practice Physician
  • Diamond Bar, CA
  • NPI 1285890624
  NPD
• Providence Medical Foundation

  • Family Medicine Physician
  • Anaheim, CA
  • NPI 1639715709
  NPD
• Providence Medical Foundation

  • Internal Medicine Physician
  • Santa Rosa, CA
  • NPI 1740584473
  NPD
• Redwood Regional Medical Group Inc

  • Hematology & Oncology Physician
  • Santa Rosa, CA
  • NPI 1275556607

  Vascular Surgery

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635897600000",
    "number": "1306879325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 US ROUTE 1",
            "address_2": "BLDG C",
            "city": "SCARBOROUGH",
            "state": "ME",
            "postal_code": "04074",
            "telephone_number": "207-885-5742",
            "fax_number": "207-885-1494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 US ROUTE 1",
            "address_2": "BLDG C",
            "city": "SCARBOROUGH",
            "state": "ME",
            "postal_code": "04074",
            "telephone_number": "207-885-5742",
            "fax_number": "207-885-1494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JICHA",
        "first_name": "DOUGLAS",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2021-11-03",
        "certification_date": "2021-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "ME",
            "license": "006810",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "132540000",
            "state": "ME"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "djicha1657855@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1162 Montgomery Dr Ste 3",
            "city": "Santa Rosa",
            "state": "CA",
            "country_code": "US",
            "postal_code": "954054802",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ryan C Jay, DO
• Ashley M Jean, MD
• Sarah Elizabeth Steele Jeney, MD
• Rosalie Jenkel
• Bethany D Jensen, MS CCC-SLP
• Ann L Johnson
• Katherine Rose Johnson, FNP-C
• Keri-Ann Johnson, LMT
• Lynda Dunn Johnson, PSY.D.
• Matthew T. Johnson, PA-C

• Vascular Surgery Physician in Scarborough, ME
• Providers in Scarborough, ME by specialty
• Vascular Surgery Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2021; 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.

Verify at the official NPI Registry.