Active NPI
Melissa Cannon
- Registered Dietitian
- Oakland, CA
National Provider Identifier
1891038113
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86009985
- Practice address
- 2950 International Blvd
Oakland, CA 94601-2228 - Phone
- (510) 535-4463
- Fax
- (510) 535-4494
- NPI assigned
- Apr 4, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | |||
| Nutrition Education Nutritionist | 133NN1002X | |||
| Registered Dietitian | 133V00000X | 86009985 | CA | Primary |
Addresses
Primary practice location
2950 International Blvd
Oakland, CA 94601-2228
Mailing address
201 Fairmount Ave
Oakland, CA 94611-5838
Phone (510) 535-4463
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689863516 | Medicaid | CA | |
| HAP11743F | Other | CA | SOFP |
| FHC11743F | 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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86009985 | CA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Native American Health Center Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Federally Qualified Health Center (FQHC)
- Oakland, CA
- NPI 1689863516
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1365033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365033600000",
"number": "1891038113",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 FAIRMOUNT AVE",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946115838",
"telephone_number": "510-535-4463",
"fax_number": "510-535-4494"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2950 INTERNATIONAL BLVD",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946012228",
"telephone_number": "510-535-4463",
"fax_number": "510-535-4494"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANNON",
"first_name": "MELISSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-04-04",
"last_updated": "2013-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": null,
"license": null,
"primary": false
},
{
"code": "133NN1002X",
"taxonomy_group": "",
"desc": "Nutritionist, Nutrition, Education",
"state": null,
"license": null,
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "86009985",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1689863516",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SOFP",
"identifier": "HAP11743F",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "FHC11743F",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.