Active NPI
Raymond Dasenbrock, MD
- Pediatrics Physician
- Cincinnati, OH
National Provider Identifier
1063467090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 35030286
- Practice address
- 4357 Ferguson Dr
Suite 150
Cincinnati, OH 45245-1689 - Phone
- (513) 753-2820
- Fax
- (513) 753-2424
- NPI assigned
- May 25, 2006
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 35030286 | OH | Primary |
Addresses
Primary practice location
4357 Ferguson Dr
Suite 150
Cincinnati, OH 45245-1689
Mailing address
5400 Dupont Circle
Suite a
Milford, OH 45150
Phone (513) 576-7700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0257832 | Medicaid | OH |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35030286 | OH | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313020800000",
"number": "1063467090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5400 DUPONT CIRCLE",
"address_2": "SUITE A",
"city": "MILFORD",
"state": "OH",
"postal_code": "45150",
"telephone_number": "513-576-7700",
"fax_number": "513-576-1020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4357 FERGUSON DR",
"address_2": "SUITE 150",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452451689",
"telephone_number": "513-753-2820",
"fax_number": "513-753-2424"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DASENBROCK",
"first_name": "RAYMOND",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-25",
"last_updated": "2011-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OH",
"license": "35030286",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0257832",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cincinnati, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.