Active NPI
Jay G Sacks, MD
- Family Medicine Physician
- Tacoma, WA
National Provider Identifier
1356431779
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 14616
- Practice address
- 1310 S Union Ave
#B1
Tacoma, WA 98405-1907 - Phone
- (253) 475-2601
- Fax
- (253) 572-8224
- NPI assigned
- Oct 14, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 14616 | WA | Primary |
Addresses
Primary practice location
1310 S Union Ave
#B1
Tacoma, WA 98405-1907
Mailing address
1310 S Union Ave
#B1
Tacoma, WA 98405-1907
Phone (253) 475-2601
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 757081059 | Other | WA | RAILROAD MEDICARE |
| 1306307 | Medicaid | WA | |
| 0016337 | Other | WA | L&I |
| SA3808 | Other | WA | REGENCE |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14616 | WA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160784000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1274227200000",
"number": "1356431779",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1310 S UNION AVE",
"address_2": "#B1",
"city": "TACOMA",
"state": "WA",
"postal_code": "984051907",
"telephone_number": "253-475-2601",
"fax_number": "253-572-8224"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1310 S UNION AVE",
"address_2": "#B1",
"city": "TACOMA",
"state": "WA",
"postal_code": "984051907",
"telephone_number": "253-475-2601",
"fax_number": "253-572-8224"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SACKS",
"first_name": "JAY",
"middle_name": "G",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-14",
"last_updated": "2010-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "14616",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "757081059",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1306307",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L&I",
"identifier": "0016337",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE",
"identifier": "SA3808",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.