Individual provider Active NPI

Ernest Dorame, M.D.

  • Pediatrics Physician
  • Phoenix, AZ
National Provider Identifier
1225019995
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
12349 Issued in AZ
Practice address
16601 N 40TH St
Suite B-120
Phoenix, AZ 85032-3345
Phone
(602) 923-7730
Fax
(602) 923-7833
NPI assigned
Nov 9, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 12349 AZ Primary

Addresses

Primary practice location

16601 N 40TH St
Suite B-120
Phoenix, AZ 85032-3345

Mailing address

3200 E Camelback Rd
Ste 250
Phoenix, AZ 85018-2327
Phone (602) 933-1813

Other identifiers 1

IdentifierTypeStateIssuer
207870MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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

Enrollment IDStateProvider typePAC IDDetails
I20170829002825 AZ Practitioner - Pediatric Medicine 9931472800 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12349AZMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Phoenix Children's Hospital Pediatrics CurrentSince Sep 1, 2017 Accepting new patients
Phoenix Children's Medical Group CurrentSince Sep 1, 2017 Accepting new patients

Locations

3200 E Camelback Rd
Ste 250
Phoenix, AZ 85018
Phone (602) 933-1814

1919 E Thomas Rd
Phoenix, AZ 85016
Phone (602) 933-0777

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1131494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1225019995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 E CAMELBACK RD",
            "address_2": "STE 250",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850182327",
            "telephone_number": "602-933-1813",
            "fax_number": "602-933-1820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16601 N 40TH ST",
            "address_2": "SUITE B-120",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850323345",
            "telephone_number": "602-923-7730",
            "fax_number": "602-923-7833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DORAME",
        "first_name": "ERNEST",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-09",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "12349",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207870",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.