Individual provider Active NPI

Jonathan L Dameworth, M.D.

  • Colon & Rectal Surgery Physician
  • Phoenix, AZ
National Provider Identifier
1194102772
Registry record updated Nov 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
License
64001 Issued in AZ
Practice address
500 W Thomas Rd Ste 400
Phoenix, AZ 85013-4238
Phone
(602) 406-3874
Fax
(602) 406-2335
NPI assigned
May 2, 2015
Last updated
Nov 6, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 6, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Colon & Rectal Surgery Physician 208C00000X 64001 AZ Primary

Addresses

Primary practice location

500 W Thomas Rd Ste 400
Phoenix, AZ 85013-4238

Mailing address

PO Box 33269
Phoenix, AZ 85067-3269
Phone (602) 406-4786

Other practice location 1

625 N 6th St
Phoenix, AZ 85004-2155
Phone (602) 406-8222

Other practice location 2

10214 N Tatum Blvd Ste A600
Phoenix, AZ 85028-4247
Phone (602) 406-1530

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, WA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20210802001138 AZ Practitioner - Colorectal Surgery (Proctology) 7214351089 Reassigns benefits to 2 organizations
I20260530000014 WA Practitioner - Colorectal Surgery (Proctology)Practitioner - General Surgery 7214351089 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Colorectal Surgery (Proctology)Also: General Surgery
Education
Creighton University School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Virginia Mason Medical CenterGroup PAC ID 9830002617, 867 clinicians
Sjhmc Physician ServicesGroup PAC ID 4486646197, 645 clinicians

Practice addresses (Care Compare)

1100 9TH Ave
Seattle, WA 98101-2756
Phone (206) 223-6600

500 W Thomas Rd
400 DHMG St. Joseph's Surgical Specialty
Phoenix, AZ 85013-4238
Phone (602) 406-3874

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy31
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
64001AZMDColon & Rectal Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph's Hospital and Medical Center CurrentSince Aug 1, 2021 Accepting new patients
St Josephs Pathology Current Accepting new patients
Sjhmc Physician Services CurrentSince Aug 1, 2021 Accepting new patients
Dignity Health PastSince Aug 1, 2021 Accepting new patients
Dignity Health Past Accepting new patients

Locations

7330 N 99th Ave
Ste 200A
Glendale, AZ 85307
Phone (602) 406-3400

10214 N Tatum Blvd
Ste A600
Phoenix, AZ 85028
Phone (602) 406-1530

350 W Thomas Rd
Phoenix, AZ 85013
Phone (480) 339-5001

500 W Thomas Rd
Ste 400
Phoenix, AZ 85013
Phone (602) 406-3874

500 W Thomas Rd
Ste 680
Phoenix, AZ 85013
Phone (602) 406-6017

625 N 6th St
Phoenix, AZ 85004
Phone (602) 406-8222

625 N 6th St
Ste 402
Phoenix, AZ 85004
Phone (602) 406-8222

File 56765
Los Angeles, CA 90074

Organizations & group practices 6

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 5

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": "1430524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730851200000",
    "number": "1194102772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 33269",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850673269",
            "telephone_number": "602-406-4786",
            "fax_number": "916-636-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W THOMAS RD STE 400",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850134238",
            "telephone_number": "602-406-3874",
            "fax_number": "602-406-2335"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "625 N 6th St",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850042155",
            "country_code": "US",
            "telephone_number": "602-406-8222",
            "fax_number": "602-406-7811",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10214 N Tatum Blvd Ste A600",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850284247",
            "country_code": "US",
            "telephone_number": "602-406-1530",
            "fax_number": "602-406-1539",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAMEWORTH",
        "first_name": "JONATHAN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-05-02",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "AZ",
            "license": "64001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.