Active NPI
Daniel Scott Domrose, DPM
- Podiatrist
- Corvallis, OR
National Provider Identifier
1417001041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- DP00264
- Practice address
- 2440 NW Professional Dr
Timber Hill Foot Clinic Daniel S Domrose DPM
Corvallis, OR 97330 - Phone
- (541) 754-9665
- Fax
- (541) 758-5706
- NPI assigned
- Jan 22, 2007
- 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 |
|---|---|---|---|---|
| Podiatrist | 213E00000X | DP00264 | OR | Primary |
Addresses
Primary practice location
2440 NW Professional Dr
Timber Hill Foot Clinic Daniel S Domrose DPM
Corvallis, OR 97330
Mailing address
2440 NW Professional Dr
Timber Hill Foot Clinic Daniel S Domrose DPM
Corvallis, OR 97330
Phone (541) 754-9665
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 073119 | Medicaid | OR | |
| DP00264 | Other | OR | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120306000651 | OR | Practitioner - Podiatry | 8628237930 | Practice locations: Corvallis, OR |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1417001041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2440 NW PROFESSIONAL DR",
"address_2": "TIMBER HILL FOOT CLINIC DANIEL S DOMROSE DPM",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "97330",
"telephone_number": "541-754-9665",
"fax_number": "541-758-5706"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2440 NW PROFESSIONAL DR",
"address_2": "TIMBER HILL FOOT CLINIC DANIEL S DOMROSE DPM",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "97330",
"telephone_number": "541-754-9665",
"fax_number": "541-758-5706"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMROSE",
"first_name": "DANIEL",
"middle_name": "SCOTT",
"credential": "DPM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "OR",
"license": "DP00264",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "073119",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "DP00264",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Corvallis, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.