Individual provider Active NPI

Dayton William Daberkow II, MD

  • Internal Medicine Physician
  • Houma, LA
National Provider Identifier
1497776413
Registry record updated Jan 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD.020829 Issued in LA
Practice address
1990 Industrial Blvd
Houma, LA 70363-7055
Phone
(985) 868-9300
Fax
(985) 851-0053
NPI assigned
Jul 23, 2006
Last updated
Jan 12, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD.020829 LA Primary

Addresses

Primary practice location

1990 Industrial Blvd
Houma, LA 70363-7055

Mailing address

1990 Industrial Blvd
Houma, LA 70363-7055
Phone (985) 868-9300

Other identifiers 1

IdentifierTypeStateIssuer
1653861MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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
I20061103000318 LA Practitioner - Internal Medicine 3173520111 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Louisiana State University School of Medicine in New Orleans, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1990 Industrial Blvd
Houma, LA 70363-7055
Phone (985) 868-9300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD.020829LAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baton Rouge Clinic, a Medical Corporation CurrentSince Jan 1, 2019 Accepting new patients
South Louisiana Medical Associates CurrentSince Jun 29, 2007 Accepting new patients
South Louisiana Medical Associates Internal Medicine CurrentSince Jun 29, 2007 Accepting new patients
Baton Rouge Clinic, a Medical Corporation Internal Medicine CurrentSince Jan 1, 2019 Accepting new patients
South Louisiana Medical Associates Cardiovascular Disease Current Accepting new patients
Hospital Medicine Group Inc Internal Medicine Past Accepting new patients
Southern Regional Medical Corporation Past Accepting new patients
Lsu Medical Center Past Accepting new patients

Locations

3600 Florida St
Baton Rouge, LA 70806
Phone (225) 381-2615

7373 Perkins Rd
Baton Rouge, LA 70808
Phone (225) 246-9790

8585 Picardy Ave
Baton Rouge, LA 70809
Phone (225) 763-4000

1990 Industrial Blvd
Houma, LA 70363
Phone (985) 868-9300

Interoperability endpoints

  • Direct secure messaging: ddaberkow100582@direct.casso.us.com

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.

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": "1153612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673481600000",
    "number": "1497776413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1990 INDUSTRIAL BLVD",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "703637055",
            "telephone_number": "985-868-9300",
            "fax_number": "985-851-0053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1990 INDUSTRIAL BLVD",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "703637055",
            "telephone_number": "985-868-9300",
            "fax_number": "985-851-0053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DABERKOW",
        "first_name": "DAYTON",
        "middle_name": "WILLIAM",
        "name_suffix": "II",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-23",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "MD.020829",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1653861",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houma, LA

Sources for this page

Verify at the official NPI Registry.