Individual provider Active NPI

Monica M Dussan, MD

  • Pediatric Endocrinology Physician
  • San Antonio, TX
National Provider Identifier
1700154267
Registry record updated Feb 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Endocrinology PhysicianTaxonomy code 2080P0205X
License
T1051 Issued in TX
Practice address
333 N Santa Rosa
San Antonio, TX 78207-3108
Phone
(210) 704-3611
Fax
(210) 704-2812
NPI assigned
Dec 12, 2011
Last updated
Feb 16, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Endocrinology Physician 2080P0205X ME132638 FL
Pediatric Endocrinology Physician 2080P0205X T1051 TX Primary

Addresses

Primary practice location

333 N Santa Rosa
San Antonio, TX 78207-3108

Mailing address

315 N San Saba Ste 1135
San Antonio, TX 78207-3255
Phone (210) 704-3030

Other identifiers 1

IdentifierTypeStateIssuer
ME132638OtherFLFLORIDA MEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20210514002508 TX Practitioner - Pediatric MedicinePractitioner - Endocrinology 0143448696 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME132638FLMDPediatric Endocrinology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baylor College of Medicine CurrentSince May 1, 2021 Accepting new patients
Christus Santa Rosa Health Care Corporation Past Accepting new patients

Locations

1 Baylor Plz
#2
Houston, TX 77030

1434 E Sonterra Blvd
Ste 300
San Antonio, TX 78258
Phone (210) 686-8050

333 N Santa Rosa
San Antonio, TX 78207
Phone (210) 704-2190

333 N Santa Rosa
Fl 4
San Antonio, TX 78207
Phone (210) 704-4140

Interoperability endpoints

  • Direct secure messaging: mdussan420514@christushealth.direct-ci.net

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1323648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676505600000",
    "number": "1700154267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 N SAN SABA STE 1135",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782073255",
            "telephone_number": "210-704-3030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 N SANTA ROSA",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782073108",
            "telephone_number": "210-704-3611",
            "fax_number": "210-704-2812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUSSAN",
        "first_name": "MONICA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-12",
        "last_updated": "2023-02-16",
        "certification_date": "2023-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0205X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": "FL",
            "license": "ME132638",
            "primary": false
        },
        {
            "code": "2080P0205X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": "TX",
            "license": "T1051",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA MEDICAL LICENSE",
            "identifier": "ME132638",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.