Active NPI
Jacob Michael Conrad
- Dentist
- San Diego, CA
National Provider Identifier
1942787296
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 102824
- Practice address
- Naval Medical Ctr
San Diego, CA 92134-0001 - Phone
- (619) 532-8600
- NPI assigned
- Jul 19, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 102824 | CA | Primary |
Addresses
Primary practice location
Naval Medical Ctr
San Diego, CA 92134-0001
Mailing address
Naval Medical Ctr
San Diego, CA 92134-5000
Phone (831) 521-8745
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| VAD0000 | 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 |
|---|---|---|---|
| 102824 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531958400000",
"number": "1942787296",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "NAVAL MEDICAL CTR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921345000",
"telephone_number": "831-521-8745"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "NAVAL MEDICAL CTR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921340001",
"telephone_number": "619-532-8600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONRAD",
"first_name": "JACOB",
"middle_name": "MICHAEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-07-19",
"last_updated": "2018-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "102824",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "VAD0000",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.