Individual provider Active NPI

Clarissa Jane Dilaveris, RD, LD

  • Registered Dietitian
  • Columbus, OH
National Provider Identifier
1275168411
Registry record updated Nov 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
LD.7440 Issued in OH
Practice address
1160 W Broad St
Columbus, OH 43222-1352
Phone
(614) 274-1455
Fax
(614) 274-1433
NPI assigned
Mar 9, 2020
Last updated
Nov 1, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 1, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X DT85859 TX
Registered Dietitian 133V00000X LD.7440 OH Primary

Addresses

Primary practice location

1160 W Broad St
Columbus, OH 43222-1352

Mailing address

2990 Bissonnet St Apt 11102
Houston, TX 77005-4074
Phone (614) 907-3022

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201203002858 OH Practitioner - Registered Dietitian Or Nutrition Professional 9931520293 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LD.7440OHMDRegistered Dietitian
DT85859TXMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Lower Lights Christian Health Center, Inc. CurrentSince Aug 20, 2020 Accepting new patients
Lower Lights Christian Health Center, Inc. Current Accepting new patients
Lower Lights Christian Health Center, Inc Current Accepting new patients
Lower Lights Christian Health Center Inc Current Accepting new patients
Lower Lights Christian Health Center, Inc Current Accepting new patients
Lower Lights Christian Health Center, Inc Current Accepting new patients
Lower Lights Christian Health Center Inc Current Accepting new patients
Lower Lights Christian Health Center Inc CurrentSince Aug 20, 2020 Accepting new patients

Locations

1160 W Broad St
Columbus, OH 43222
Phone (614) 947-7615

L3957
Columbus, OH 43260

Interoperability endpoints

  • Direct secure messaging: cdilaveris630771@direct.ochin.org

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1583712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698796800000",
    "number": "1275168411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2990 BISSONNET ST APT 11102",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770054074",
            "telephone_number": "614-907-3022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 W BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432221352",
            "telephone_number": "614-274-1455",
            "fax_number": "614-274-1433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DILAVERIS",
        "first_name": "CLARISSA",
        "middle_name": "JANE",
        "credential": "RD, LD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-09",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TX",
            "license": "DT85859",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "OH",
            "license": "LD.7440",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.