Individual provider Active NPI

Mariah Claire Domer Saratan

  • Registered Nurse
  • Fort Worth, TX
National Provider Identifier
1215539358
Registry record updated Nov 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
926648 Issued in TX
Practice address
3250 River Lodge TRL S Apt 439
Fort Worth, TX 76116-0832
Phone
(408) 329-8650
NPI assigned
Nov 13, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 926648 TX Primary

Addresses

Primary practice location

3250 River Lodge TRL S Apt 439
Fort Worth, TX 76116-0832

Mailing address

3250 River Lodge TRL S Apt 439
Fort Worth, TX 76116-0832
Phone (408) 329-8650

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

LicenseStateTypeSpecialty
926648TXMDRegistered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1605225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605225600000",
    "number": "1215539358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3250 RIVER LODGE TRL S APT 439",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761160832",
            "telephone_number": "408-329-8650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3250 RIVER LODGE TRL S APT 439",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761160832",
            "telephone_number": "408-329-8650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SARATAN",
        "first_name": "MARIAH CLAIRE",
        "middle_name": "DOMER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-13",
        "last_updated": "2020-11-13",
        "certification_date": "2020-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "926648",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.