Active NPI
Pheonix Ellis Sinclair, D.D.S.
- General Practice Dentistry
- Shingle Springs, CA
National Provider Identifier
1952450686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D25841
- Practice address
- 4140 Mother Lode Dr
Suite 112
Shingle Springs, CA 95682-8038 - Phone
- (530) 672-8059
- Fax
- (530) 672-2111
- NPI assigned
- Jan 10, 2007
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D25841 | CA | Primary |
Addresses
Primary practice location
4140 Mother Lode Dr
Suite 112
Shingle Springs, CA 95682-8038
Mailing address
3335 Rolls Dr
Cameron Park, CA 95682-9246
Phone (530) 676-7197
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| THP70630F | Medicaid | CA | |
| D25841 | Other | CA | DENTAL |
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 |
|---|---|---|---|
| D25841 | CA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shingle Springs Rancheria | 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.
-
- Health Service Clinic/Center
- Placerville, CA
- NPI 1245356674
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1952450686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3335 ROLLS DR",
"city": "CAMERON PARK",
"state": "CA",
"postal_code": "956829246",
"telephone_number": "530-676-7197",
"fax_number": "530-676-7198"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4140 MOTHER LODE DR",
"address_2": "SUITE 112",
"city": "SHINGLE SPRINGS",
"state": "CA",
"postal_code": "956828038",
"telephone_number": "530-672-8059",
"fax_number": "530-672-2111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SINCLAIR",
"first_name": "PHEONIX",
"middle_name": "ELLIS",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-10",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "D25841",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "THP70630F",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL",
"identifier": "D25841",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shingle Springs, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.