Renee Diane Lass, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

3589 Issued in IA

Practice address

4626 Progress Dr
Suite B
Davenport, IA 52807-3485

Phone

(563) 359-3736

Fax

(563) 359-0153

NPI assigned

Mar 28, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

Practice roles

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

• Bettendorf Pediatric Group

  • Family Medicine Physician
  • Bettendorf, IA
  • NPI 1942562467

  Family Medicine

  NPD (past)
• Narinder Kumar Dba Bettendorf Pediatric & Family Practice Assoc.

  • Pediatrics Physician
  • Bettendorf, IA
  • NPI 1609902469

  Family Medicine

  NPD (past)
• Fort Wayne Medical Education Program

  • Family Medicine Physician
  • Fort Wayne, IN
  • NPI 1184635153

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437436800000",
    "number": "1174584445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4626 PROGRESS DR",
            "address_2": "SUITE B",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073485",
            "telephone_number": "563-359-3736",
            "fax_number": "563-359-0153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4626 PROGRESS DR",
            "address_2": "SUITE B",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073485",
            "telephone_number": "563-359-3736",
            "fax_number": "563-359-0153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LASS",
        "first_name": "RENEE",
        "middle_name": "DIANE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-28",
        "last_updated": "2015-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "3589",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "04386",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3444885",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marcia Lynn Larkin, RN
• Carolyn Peters Larsen, D.D.S.
• James Andrew Larsen, D.D.S.
• Amber Elizabeth Larson, SLP
• Daniel Larson, ED.D.
• Amanda Noel Lauer, PMHNP
• Michael Laughlin, DDS
• Lauri a Harsh
• Hemali Lawande
• Dana Jeffrey Lawrence, DC

• All providers in Davenport, IA
• Family Medicine Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.