Organization Active NPI

Amy J Daros DO PC

  • Geriatric Medicine (Family Medicine) Physician
  • Flint, MI
National Provider Identifier
1710058680
Registry record updated Nov 6, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
5101012998 Issued in MI
Legal business name
AMY J DAROS DO PC
Practice address
5065 Miller Rd
Flint, MI 48507-1037
Phone
(810) 230-0338
Fax
(810) 230-0595
NPI assigned
Nov 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2007

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

Authorized official

Name
Amy J Daros, DONPI 1164443487
Title
Owner President
Phone
(810) 230-0338

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QG0300X 5101012998 MI Primary

Addresses

Primary practice location

5065 Miller Rd
Flint, MI 48507-1037

Mailing address

PO Box 887
Grand Blanc, MI 48480-0887
Phone (810) 230-0338

Other identifiers 2

IdentifierTypeStateIssuer
4250600MedicaidMI
0856311114OtherMIBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040807000165 MI Part B Supplier - Clinic/Group Practice 9638141906 Receives reassigned benefits from 1 practitioner
Practice locations: Flint, MI

National Provider Directory

National Provider Directory

Locations

5065 Miller Rd
Flint, MI 48507
Phone (810) 732-6780

8275 Holly Rd
Ste 1A
Grand Blanc, MI 48439
Phone (810) 972-9722

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194307200000",
    "number": "1710058680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 887",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484800887",
            "telephone_number": "810-230-0338",
            "fax_number": "810-230-0595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5065 MILLER RD",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485071037",
            "telephone_number": "810-230-0338",
            "fax_number": "810-230-0595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMY J DAROS DO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2007-11-06",
        "status": "A",
        "authorized_official_last_name": "DAROS",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "810-230-0338",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "MI",
            "license": "5101012998",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4250600",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0856311114",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flint, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.