NPIMap

Organization Active NPI

T Daniel Dibble MD PC

Doing business as Spine Team Spokane

  • Interventional Pain Medicine Physician
  • Spokane Valley, WA
National Provider Identifier
1780754499
Registry record updated Jul 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
MD00042632 Issued in WA
Legal business name
T DANIEL DIBBLE MD PC
Doing business as
Spine Team Spokane
Practice address
1123 N Evergreen Rd
Spokane Valley, WA 99216-1138
Phone
(509) 363-3100
Fax
(509) 363-0300
NPI assigned
Nov 9, 2006
Last updated
Jul 17, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2023

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

Authorized official

Name
T Daniel Dibble, MD
Title
President
Phone
(509) 363-3100

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X M-7950 ID
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X MD00048246 WA
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X MD00042632 WA Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT60041936 WA
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X PA10003398 WA

Addresses

Primary practice location

1123 N Evergreen Rd
Spokane Valley, WA 99216-1138

Mailing address

PO Box 808
Veradale, WA 99037-0808
Phone (509) 363-3100

Other practice location 1

510 E Holland Ave
Spokane, WA 99218-1206
Phone (509) 363-3100

Other identifiers 2

IdentifierTypeStateIssuer
217798OtherWALABOR AND INDUSTRIES
805808900MedicaidID

Other names 1

  • SPINE TEAM SPOKANE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, ID3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040507001165 WA Part B Supplier - Clinic/Group Practice 1254320922 Receives reassigned benefits from 16 practitioners
Practice locations: Spokane, WA; Spokane Valley, WA
O20050728001068 ID Part B Supplier - Clinic/Group Practice 1254320922 Receives reassigned benefits from 6 practitioners
Practice locations: Coeur D Alene, ID
O20220110000199 WA DME Supplier - Physician - Anesthesiology 1254320922 Practice locations: Spokane Valley, WA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2175720Spine Team Spokane1123 N Evergreen Rd, Spokane Valley, WA 99216ComplianceApr 4, 2028

National Provider Directory

National Provider Directory

Locations

2190 W Ironwood Center Dr
Coeur D Alene, ID 83814
Phone (208) 667-1104

510 E Holland Ave
Spokane, WA 99218
Phone (509) 363-3100

1123 N Evergreen Rd
Ste 101
Spokane Valley, WA 99216

1117 N Evergreen Rd
#2
Spokane Valley, WA 99216

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689552000000",
    "number": "1780754499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 808",
            "city": "VERADALE",
            "state": "WA",
            "postal_code": "990370808",
            "telephone_number": "509-363-3100",
            "fax_number": "509-363-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1123 N EVERGREEN RD",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992161138",
            "telephone_number": "509-363-3100",
            "fax_number": "509-363-0300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "510 E Holland Ave",
            "address_purpose": "LOCATION",
            "city": "Spokane",
            "state": "WA",
            "postal_code": "992181206",
            "country_code": "US",
            "telephone_number": "509-363-3100",
            "fax_number": "509-363-0300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "T DANIEL DIBBLE MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A",
        "authorized_official_last_name": "DIBBLE",
        "authorized_official_first_name": "T",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "509-363-3100",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "ID",
            "license": "M-7950",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "WA",
            "license": "MD00048246",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "WA",
            "license": "MD00042632",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60041936",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA10003398",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES",
            "identifier": "217798",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805808900",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SPINE TEAM SPOKANE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SPINE TEAM SPOKANE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spokane Valley, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.