Active NPI
Douglas X Dismuke I
- Case Manager/Care Coordinator
- Toledo, OH
National Provider Identifier
1104696608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- License
- 171M00000X
- Practice address
- 3649 Revere Dr
Toledo, OH 43612-1032 - Phone
- (815) 299-8765
- NPI assigned
- Jan 5, 2024
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | 171M00000X | OH | Primary |
Addresses
Primary practice location
3649 Revere Dr
Toledo, OH 43612-1032
Mailing address
3649 Revere Dr
Toledo, OH 43612-1032
Phone (815) 299-8765
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 |
|---|---|---|---|
| 171M00000X | OH | MD | Case Manager/Care Coordinator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1704412800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705017600000",
"number": "1104696608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3649 REVERE DR",
"city": "TOLEDO",
"state": "OH",
"postal_code": "436121032",
"telephone_number": "815-299-8765"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3649 REVERE DR",
"city": "TOLEDO",
"state": "OH",
"postal_code": "436121032",
"telephone_number": "815-299-8765"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DISMUKE",
"first_name": "DOUGLAS",
"middle_name": "X",
"name_prefix": "Mr.",
"name_suffix": "I",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-01-05",
"last_updated": "2024-01-12",
"certification_date": "2024-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "OH",
"license": "171M00000X",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Toledo, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.