Jackson Sittenauer, MD

Primary specialty

Military Health Care ProviderTaxonomy code 171000000X

License

0101267940 Issued in VA

Practice address

593 Eddy St
Providence, RI 02903-4923

Phone

(785) 221-0744

NPI assigned

May 3, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1525305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711152000000",
    "number": "1831688084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "785-221-0744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "785-221-0744"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3475 N Saratoga St",
            "address_purpose": "LOCATION",
            "city": "Oak Harbor",
            "state": "WA",
            "postal_code": "982784927",
            "country_code": "US",
            "telephone_number": "360-257-9500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8901 Wisconsin Ave",
            "address_purpose": "LOCATION",
            "city": "Bethesda",
            "state": "MD",
            "postal_code": "208890004",
            "country_code": "US",
            "telephone_number": "301-295-9283",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4735 E Marginal Way S Ste 1201",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981342380",
            "country_code": "US",
            "telephone_number": "785-221-0744",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SITTENAUER",
        "first_name": "JACKSON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-03",
        "last_updated": "2024-03-23",
        "certification_date": "2024-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": "VA",
            "license": "0101267940",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A193407",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "OH",
            "license": "35.150161",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "AR",
            "license": "E-17506",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Varfeeta Sirleaf
• Michael Sisitsky, MD
• Nikolaos Sismanopoulos, M.D
• Lauren Elizabeth Sisson, FNP-BC
• Erica Sistare, CGC
• Matthew Kyle Siubis, PA-C
• Devyani Sivakumar, MD
• Latha Sivaprasad, MD
• Arvind Sivashanmugam, MD
• Naomi Stasia Siwy, FNP-C

• Military Health Care Provider in Providence, RI
• Providers in Providence, RI by specialty
• Military Health Care Provider in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.