Individual provider Active NPI

Denise Lynne Davis, M.D.

  • Internal Medicine Physician
  • Berkeley, CA
National Provider Identifier
1851311245
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G057866 Issued in CA
Practice address
3031 Telegraph Ave
Suite 217
Berkeley, CA 94705-2051
Phone
(510) 883-1046
Fax
(510) 883-1746
NPI assigned
Jul 20, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X G057866 CA Primary

Addresses

Primary practice location

3031 Telegraph Ave
Suite 217
Berkeley, CA 94705-2051

Mailing address

3031 Telegraph Ave
Suite 217
Berkeley, CA 94705-2051
Phone (510) 883-1046

Other identifiers 1

IdentifierTypeStateIssuer
G57866MedicaidCA

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141028001509 CA Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 0547363095

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G057866CAMDInternal Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1851311245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3031 TELEGRAPH AVE",
            "address_2": "SUITE 217",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947052051",
            "telephone_number": "510-883-1046",
            "fax_number": "510-883-1746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3031 TELEGRAPH AVE",
            "address_2": "SUITE 217",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947052051",
            "telephone_number": "510-883-1046",
            "fax_number": "510-883-1746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "DENISE",
        "middle_name": "LYNNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G057866",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G57866",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berkeley, CA

Sources for this page

Verify at the official NPI Registry.