Domenic Derobertis, CAA

Primary specialty

Anesthesiologist AssistantTaxonomy code 367H00000X

License

AA698 Issued in FL

Practice address

1150 Varnum St NE
Washington, DC 20017-2104

Phone

(202) 854-7000

NPI assigned

May 15, 2017

Last updated

Mar 10, 2025By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Associate of Arts

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northwood Anesthesia Associates LLC

  • Anesthesiology Physician
  • Venice, FL
  • NPI 1811569197
  Medicare reassignment NPD
• Northwood Anesthesia Associates LLC

  • Anesthesiology Physician
  • Wesley Chapel, FL
  • NPI 1528630803
  NPD
• Northwood Anesthesia Associates LLC

  • Anesthesiology Physician
  • Trinity, FL
  • NPI 1780256073
  NPD
• Providence Health Services, Inc

  dba PHS Anesthesia

  • Anesthesiology Physician
  • Washington, DC
  • NPI 1740795293

  Anesthesiologist Assistant

  NPD (past)

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

{
    "created_epoch": "1494806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741564800000",
    "number": "1023545530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13661 SAMHILL LN",
            "city": "MOUNT AIRY",
            "state": "MD",
            "postal_code": "217714578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 VARNUM ST NE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172104",
            "telephone_number": "202-854-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEROBERTIS",
        "first_name": "DOMENIC",
        "credential": "CAA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-15",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "FL",
            "license": "AA698",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lemise Deribe
• Netsanet Deribe
• Jenna Eliz Tan Derivera, CAA
• Dermatology Associates, P.C.
• Dermoptica Inc.
• Lauren Derosa
• Michele Derose
• Aisha T Derricott
• Darone A Derricott Sr.
• Taji Derry

• Anesthesiologist Assistant in Washington, DC
• Providers in Washington, DC by specialty
• Anesthesiologist Assistant in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.