Erin Dimambro, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601004781 Issued in MI

Practice address

1201 Stone St
Ste 5
Port Huron, MI 48060-3563

Phone

(810) 966-9556

Fax

(810) 966-4898

NPI assigned

Jul 25, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• McLaren Port Huron

  • Psychiatry Physician
  • Port Huron, MI
  • NPI 1386888170
  Medicare reassignment
• McLaren Port Huron

  • Family Medicine Physician
  • Port Huron, MI
  • NPI 1619355930
  NPD

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447372800000",
    "number": "1477576163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 STONE ST",
            "address_2": "STE 5",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603563",
            "telephone_number": "810-966-9556",
            "fax_number": "810-966-4898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 STONE ST",
            "address_2": "STE 5",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603563",
            "telephone_number": "810-966-9556",
            "fax_number": "810-966-4898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIMAMBRO",
        "first_name": "ERIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-25",
        "last_updated": "2015-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601004781",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "5601004781",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Dickinson
• Samantha Jean Dickson
• Debra Dietrich
• Daniel Dillingham
• Madison Dillon, PMHNP
• Kelly D Distelrath, LLP
• Rachel Distelrath, FNP-BC
• Diversified Behavioral Health Solutions
• Patricia Louise Dixon
• Sharon Ruth Doan, M.A., CCC-A

• Physician Assistant in Port Huron, MI
• Providers in Port Huron, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2015; 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.

Verify at the official NPI Registry.