NPIMap

Organization Active NPI

1150 Main Street Inc

  • Family Medicine Physician
  • Watsonville, CA
National Provider Identifier
1912347261
Registry record updated Jul 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G56281 Issued in CA
Legal business name
1150 MAIN STREET INC
Practice address
1150 Main St Ste 3
Watsonville, CA 95076-3760
Phone
(831) 728-0551
Fax
(831) 728-3679
NPI assigned
Jul 1, 2013
Last updated
Jul 1, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2013

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

Authorized official

Name
Shirley L Dickinson, M.D.NPI 1679500565
Title
Manager
Phone
(831) 728-0551

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X G56281 CA Primary

Addresses

Primary practice location

1150 Main St Ste 3
Watsonville, CA 95076-3760

Mailing address

1150 Main St Ste 3
Watsonville, CA 95076-3760
Phone (831) 728-0551

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1372636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372636800000",
    "number": "1912347261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 MAIN ST STE 3",
            "city": "WATSONVILLE",
            "state": "CA",
            "postal_code": "950763760",
            "telephone_number": "831-728-0551",
            "fax_number": "831-728-3679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 MAIN ST STE 3",
            "city": "WATSONVILLE",
            "state": "CA",
            "postal_code": "950763760",
            "telephone_number": "831-728-0551",
            "fax_number": "831-728-3679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1150 MAIN STREET INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-01",
        "last_updated": "2013-07-01",
        "status": "A",
        "authorized_official_last_name": "DICKINSON",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "831-728-0551",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G56281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watsonville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 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.

Verify at the official NPI Registry.