Active NPI
Polina Tsouzmer, DDS
- General Practice Dentistry
- Fairfield, CA
National Provider Identifier
1396833562
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 53285
- Practice address
- 1955 Texas St
Suite 12
Fairfield, CA 94533-4462 - Phone
- (707) 428-5400
- NPI assigned
- Oct 11, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 53285 | CA | Primary |
Addresses
Primary practice location
1955 Texas St
Suite 12
Fairfield, CA 94533-4462
Mailing address
310 N Civic Dr
Apt 309
Walnut Creek, CA 94596-3664
Phone (415) 335-2297
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
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160120002554 | CA | Order and Referring Only - Oral Surgery | 9234432550 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53285 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1372118400000",
"number": "1396833562",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "310 N CIVIC DR",
"address_2": "APT 309",
"city": "WALNUT CREEK",
"state": "CA",
"postal_code": "945963664",
"telephone_number": "415-335-2297"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1955 TEXAS ST",
"address_2": "SUITE 12",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945334462",
"telephone_number": "707-428-5400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TSOUZMER",
"first_name": "POLINA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-11",
"last_updated": "2013-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "53285",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2013; 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.