James Alvin Douglas, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12006702A Issued in IN

Practice address

820 E Colfax Ave
South Bend, IN 46617-2804

Phone

(574) 289-5776

Fax

(574) 289-5777

NPI assigned

May 9, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1210291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210291200000",
    "number": "1619144672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 E COLFAX AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172804",
            "telephone_number": "574-289-5776",
            "fax_number": "574-289-5777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 E COLFAX AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172804",
            "telephone_number": "574-289-5776",
            "fax_number": "574-289-5777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "JAMES",
        "middle_name": "ALVIN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-09",
        "last_updated": "2008-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12006702A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rita Donley, PH.D.
• Amanda Keri Dorman, MA, BCBA
• Douglas J Kosek D.D.S., P.C.
• Douglas J Kosek DDS PC
• David Wood Douglas, D.D.S.
• Kevin Matthew Downey, DDS
• Jacob Andrew Downs
• Allison Elizabeth Doyle, APNP
• Erica Doyle, SLP
• Grace Alison Doyle

• General Practice Dentistry in South Bend, IN
• Providers in South Bend, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2008; 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.