Individual provider Active NPI

Douglas Robert Dohl, M.D.

  • Anesthesiology Physician
  • Fort Wayne, IN
National Provider Identifier
1285832477
Registry record updated Oct 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
11013875A Issued in IN
Practice address
5050 N Clinton St
Fort Wayne, IN 46825-5886
Phone
(260) 484-8551
Fax
(260) 482-5060
NPI assigned
Jul 10, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 11013875A IN Primary

Addresses

Primary practice location

5050 N Clinton St
Fort Wayne, IN 46825-5886

Mailing address

5052 N Clinton St
Fort Wayne, IN 46825-5822
Phone (260) 484-8551

Other identifiers 1

IdentifierTypeStateIssuer
201023220MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20110617000004 IN Practitioner - Anesthesiology 2466630694 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Indiana University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Surgery One Anesthesia LLCGroup PAC ID 8820351463, 32 clinicians

Practice addresses (Care Compare)

5050 N Clinton St
Fort Wayne, IN 46825-5886
Phone (260) 484-8551

Hospital & facility affiliations

  • Orthopaedic Hospital at Parkview North Hospital, Fort Wayne, IN, CCN 150167

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11013875AINMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Surgery One Anesthesia, LLC Anesthesiology CurrentSince Jul 1, 2018 Accepting new patients

Locations

5050 N Clinton St
Fort Wayne, IN 46825
Phone (219) 484-8551

5052 N Clinton St
Fort Wayne, IN 46825
Phone (260) 408-2203

Organizations & group practices 1

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.

Hospital & facility affiliations 1

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": "1184025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540166400000",
    "number": "1285832477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5052 N CLINTON ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468255822",
            "telephone_number": "260-484-8551",
            "fax_number": "260-482-5060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 N CLINTON ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468255886",
            "telephone_number": "260-484-8551",
            "fax_number": "260-482-5060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOHL",
        "first_name": "DOUGLAS",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-10",
        "last_updated": "2018-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IN",
            "license": "11013875A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201023220",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.