DR. JERRY DEAN FAIN (NPI# 1447293840) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447293840 |
| Entity Type | Individual |
| Full Name | DR. JERRY DEAN FAIN |
| Credential | M.D. |
| Practice Address |
901 W 38th St Suite 200 Austin TX 78705-1165 |
| Mailing Address |
Po Box 911230 Dallas TX 75391-1230 |
| Practice Telephone | 5124199733 |
| Practice Fax Number | 5124513709 |
| Mailing Telephone | 9729978000 |
| Mailing Fax Number | 9722340813 |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2009-01-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
H4310 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | BCBS OF TX | 8BP225 | 01 |
| TX | RAILROAD MEDICARE NUMBER | 830004599 | 01 |
| TX | 131313208 | 05 | |
| TX | RAILROAD MEDICARE | P00645999 | 01 |
| TX | 131313207 | 05 | |
| TX | 131313202 | 05 |
| Street Address |
901 W 38TH ST SUITE 200 |
| City | AUSTIN |
| State | TX |
| Zip Code | 78705-1165 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609861897 | Russell A Hayhurst | Ophthalmology | 901 W 38th St, Ste 303, Austin, TX 78705-1163 | 2005-09-14 |
| 1124598917 | Seton Oral & Maxillofacial Surgery | Dentist | 901 W 38th St, Suite 410, Austin, TX 78705 | 2018-12-05 |
| 1437532850 | Wilshire Interventional Pain Center LLC | Nurse Anesthetist, Certified Registered | 901 W 38th St, Suite 101, Austin, TX 78705-1163 | 2015-07-02 |
| 1336522754 | Sc Spine Partners LLC | Nurse Anesthetist, Certified Registered | 901 W 38th St, Suite 101, Austin, TX 78705-1163 | 2015-07-02 |
| 1609265891 | Abs Spine Partners LLC | Clinic/Center | 901 W 38th St, Suite 101, Austin, TX 78705-1163 | 2015-01-12 |
| 1972925105 | Michelle Kim | Dentist | 901 W 38th St, Suite 410, Austin, TX 78705-1163 | 2014-01-07 |
| 1457617821 | Westlake Interventional Pain Center LLC | Clinic/Center | 901 W 38th St, Suite 101, Austin, TX 78705-1163 | 2012-04-10 |
| 1992071922 | Cristina Salazar | Physician Assistant | 901 W 38th St, Suite 301, Austin, TX 78705-1163 | 2012-03-23 |
| 1174897870 | Rachel Alicia Smith | Physician Assistant | 901 W 38th St, Suite 200, Austin, TX 78705-1163 | 2012-02-28 |
| 1720370760 | Lauren Nicole Sederholm | Physician Assistant | 901 W 38th St, Suite 200, Austin, TX 78705-1163 | 2011-05-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740894559 | Ben Aviel | Specialist/Technologist | 2501 Leon, Austin, TX 78705 | 2020-08-31 |
| 1700408739 | Julie Marie Dorland | Obstetrics & Gynecology | Ut Austin Dell Medical School Obgyn Medical Park Tower, 1301 W 38th St, Suite 705, Austin, TX 78705 | 2020-05-13 |
| 1952941155 | Oluwakemi Yemi-ese | Counselor | 2717 Rio Grande Street, Austin, TX 78705 | 2020-01-15 |
| 1285272765 | Lisa K Wheeler | Counselor | 2520 Longivew Street, Suite 313, Austin, TX 78705 | 2019-12-16 |
| 1033767637 | Olivia May Neel | Specialist/Technologist | 620 West 24th Street, 208a, Austin, TX 78705 | 2019-08-28 |
| 1336795202 | Grace Evelyn Martin | Specialist/Technologist | University of Texas, 110 Inner Campus Drive, Austin, TX 78705 | 2019-08-15 |
| 1801450317 | Nicole Buchele | Obstetrics & Gynecology | Ut Austin Dell Medical School-obgyn, Medical Park Tower, 1301 W 38th St, Suite 705, Austin, TX 78705 | 2019-04-30 |
| 1124502794 | Joan Margaret Carroll | Physician Assistant | 3000 N, I-35, Suite 600, Austin, TX 78705 | 2018-09-19 |
| 1841797636 | Corbin Anne Weaver | Obstetrics & Gynecology | Medical Park Tower, 1301 W. 38th St., Suite 705, Austin, TX 78705 | 2018-04-09 |
| 1740707892 | Christine Marie Falk | Specialist/Technologist | 2810 Hemphill Park, Apt 211, Austin, TX 78705 | 2017-08-29 |
| Find all providers in zip 78705 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205079373 | Andrae Lavon Vandross | Internal Medicine | 12221 Renfert Way, Suite 120 and 300, Austin, TX 78758 | 2009-04-19 |
| 1982661674 | Shubhada S. Shrikhande | Internal Medicine | 12221 Renfert Way Ste 300, Austin, TX 78758-5453 | 2006-04-27 |
| 1134186166 | Rene Castillo | Internal Medicine | 901 West 38th St., Suite 200, Austin, TX 78705-1165 | 2006-04-26 |
| 1124089412 | Christopher Owen Ruud | Internal Medicine | 901 W 38th St Ste 200, Austin, TX 78705-1165 | 2006-03-28 |
| 1215912076 | Uri M Mintz | Internal Medicine | 11044 Research Blvd, D400, Austin, TX 78759-5263 | 2005-12-14 |
| 1477815249 | Tara Kaufmann | Internal Medicine | 1601 Trinity St, Austin, TX 78712-1765 | 2012-06-08 |
| 1104153592 | Austin Diagnostic Clinic, Pa | Internal Medicine | 12221 N Mo Pac Expy, Austin, TX 78758-2401 | 2009-11-06 |
| 1972770303 | Texas Oncology Pa | Internal Medicine | 4101 James Casey St, Suite 100, Austin, TX 78745-3325 | 2008-05-14 |
| 1164502423 | Mamta Kalidas | Internal Medicine | 12221 N Mo Pac Expy, Austin, TX 78758-2401 | 2006-10-17 |
| 1467548628 | Allison Elaine Gorrebeeck | Internal Medicine | 12221 Renfert Way Ste 300, Austin, TX 78758 | 2006-10-05 |
| Find all providers in AUSTIN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.