Dominick Detommaso, D.P.M.

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

07000410A Issued in IN

Practice address

7601 W Jefferson Blvd
Fort Wayne, IN 46804-4133

Phone

(260) 436-8686

Fax

(260) 436-8585

NPI assigned

May 23, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458604800000",
    "number": "1013910041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7601 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044133",
            "telephone_number": "260-436-8686",
            "fax_number": "260-436-8585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7601 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044133",
            "telephone_number": "260-436-8686",
            "fax_number": "260-436-8585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETOMMASO",
        "first_name": "DOMINICK",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-23",
        "last_updated": "2016-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IN",
            "license": "07000410A",
            "primary": true
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IN",
            "license": "07000410A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100053980A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "00000089407",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "200021084",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angela C Despenza, LPN
• Destiny Life Center Cog
• Kristi Detar, RBT
• Hannah Kay Detmer
• Alyssa L. Detommaso, PA-C
• Jonathan Detommaso, DPM
• Arthur W Detore, M.D.
• Rachael Dettling
• Jonathan Dettmer, PT
• Kristen Dettmer, PNP

• Foot & Ankle Surgery Podiatrist in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Foot & Ankle Surgery Podiatrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2016; 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.