Active NPI
Derek M Ross, DDS
- Dentist
- Eaton, OH
National Provider Identifier
1316353915
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 30024200
- Practice address
- 109 E Washington Jackson Rd Ste a
Eaton, OH 45320-9793 - Phone
- (937) 456-4747
- NPI assigned
- Jul 3, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 30024200 | OH | Primary |
Addresses
Primary practice location
109 E Washington Jackson Rd Ste a
Eaton, OH 45320-9793
Mailing address
109 E Washington Jackson Rd Ste a
Eaton, OH 45320-9793
Phone (937) 456-4747
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30024200 | OH | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404345600000",
"number": "1316353915",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 E WASHINGTON JACKSON RD STE A",
"city": "EATON",
"state": "OH",
"postal_code": "453209793",
"telephone_number": "937-456-4747"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 E WASHINGTON JACKSON RD STE A",
"city": "EATON",
"state": "OH",
"postal_code": "453209793",
"telephone_number": "937-456-4747"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSS",
"first_name": "DEREK",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-07-03",
"last_updated": "2014-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "30024200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eaton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.