NPIMap

Individual provider Active NPI

Daniel Thomas Dubose, MD FACS

  • Otolaryngology/Facial Plastic Surgery Physician
  • Sonora, CA
National Provider Identifier
1164437471
Registry record updated Apr 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X
License
G670890 Issued in CA
Practice address
795 Morning Star Drive
Sonora, CA 95370
Phone
(209) 533-2545
Fax
(209) 533-0924
NPI assigned
Jul 29, 2006
Last updated
Apr 24, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X G670890 CA Primary

Addresses

Primary practice location

795 Morning Star Drive
Sonora, CA 95370

Mailing address

795 Morning Star Drive
Sonora, CA 95370
Phone (209) 533-2545

Other identifiers 2

IdentifierTypeStateIssuer
00G670890MedicaidCA
040011285OtherCARAILROAD RETIREMENT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041005000482 CA Practitioner - OtolaryngologyPractitioner - Allergy/ImmunologyPractitioner - Plastic and Reconstructive Surgery 9234198409 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Loma Linda University School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sonora Community HospitalGroup PAC ID 4284538505, 134 clinicians

Practice addresses (Care Compare)

1000 Greenley Rd
Sonora, CA 95370-5200
Phone (209) 536-5000

193 Fairview LN
Sonora, CA 95370-4828
Phone (209) 536-5100

680 Guzzi LN
Sonora, CA 95370-5288

795 Morning Star Dr
Sonora, CA 95370-5193
Phone (209) 536-3680

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.78 of 100Reported as group
Quality
81.74
Promoting interoperability
97
Improvement activities
40
Cost
67.27

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision38
Removal of skin lesions82
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G670890CAMDOtolaryngology/Facial Plastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sonora Community Hospital CurrentSince May 1, 2010 Accepting new patients
Sonora Community Hospital CurrentSince May 1, 2010 Accepting new patients
Sonora Community Hospital Current Accepting new patients
Sonora Community Hospital Past Accepting new patients
Greenley Oaks Ear, Nose & Throat, Apc PastSince Feb 22, 2005 Accepting new patients

Locations

14542 Lolly Ln
Sonora, CA 95370
Phone (209) 536-3625

193 Fairview Ln
Ste B
Sonora, CA 95370
Phone (209) 532-5100

193 Fairview Ln
Ste C
Sonora, CA 95370
Phone (209) 533-3321

680 Guzzi Ln
Ste 106
Sonora, CA 95370
Phone (209) 532-2792

680 Guzzi Ln
Ste 201
Sonora, CA 95370
Phone (209) 536-1785

795 Morning Star Dr
Sonora, CA 95370
Phone (209) 533-2545

Organizations & group practices 5

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.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208995200000",
    "number": "1164437471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "795 MORNING STAR DRIVE",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "95370",
            "telephone_number": "209-533-2545",
            "fax_number": "209-533-0924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "795 MORNING STAR DRIVE",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "95370",
            "telephone_number": "209-533-2545",
            "fax_number": "209-533-0924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUBOSE",
        "first_name": "DANIEL",
        "middle_name": "THOMAS",
        "name_prefix": "Mr.",
        "credential": "MD FACS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-29",
        "last_updated": "2008-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "CA",
            "license": "G670890",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G670890",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD RETIREMENT",
            "identifier": "040011285",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sonora, CA

Sources for this page

Verify at the official NPI Registry.