Active NPI
Dennis A Nousaine, M.D.
- Internal Medicine Physician
- Jackson, CA
National Provider Identifier
1528079621
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- C35000
- Practice address
- 815 Court St
Ste 7
Jackson, CA 95642-2154 - Phone
- (209) 257-5900
- Fax
- (209) 257-5901
- NPI assigned
- Aug 11, 2006
- Last updated
- Jul 9, 2015
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | C35000 | CA | Primary |
Addresses
Primary practice location
815 Court St
Ste 7
Jackson, CA 95642-2154
Mailing address
10470 Old Placerville Rd
Suite 100
Sacramento, CA 95827-2539
Phone (800) 470-0071
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00C350000 | Medicaid | CA |
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 |
|---|---|---|---|
| 35000 | CA | MD | Clinical Psychologist |
| C35000 | CA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436400000000",
"number": "1528079621",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10470 OLD PLACERVILLE RD",
"address_2": "SUITE 100",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958272539",
"telephone_number": "800-470-0071"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "815 COURT ST",
"address_2": "STE 7",
"city": "JACKSON",
"state": "CA",
"postal_code": "956422154",
"telephone_number": "209-257-5900",
"fax_number": "209-257-5901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOUSAINE",
"first_name": "DENNIS",
"middle_name": "A",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-11",
"last_updated": "2015-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CA",
"license": "C35000",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00C350000",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.