Individual provider Active NPI

Paul Larry Dassow, MD

  • Family Medicine Physician
  • Chattanooga, TN
National Provider Identifier
1790729572
Registry record updated Jun 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
34878 Issued in KY
Practice address
1100 E 3Rd St
Chattanooga, TN 37403-2241
Phone
(423) 778-9300
Fax
(423) 778-9301
NPI assigned
Jun 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2012

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 34878 KY Primary
Adolescent Medicine (Family Medicine) Physician 207QA0000X 34878 KY
Adult Medicine Physician 207QA0505X 34878 KY
Geriatric Medicine (Family Medicine) Physician 207QG0300X 34878 KY

Addresses

Primary practice location

1100 E 3Rd St
Chattanooga, TN 37403-2241

Mailing address

PO Box 11023
Chattanooga, TN 37401-2023
Phone (423) 778-9300

Other identifiers 1

IdentifierTypeStateIssuer
64348782MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20260403000655 GA Order and Referring Only - Family PracticePractitioner - Family Practice 4880650910

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34878KYMDFamily Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340755200000",
    "number": "1790729572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11023",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374012023",
            "telephone_number": "423-778-9300",
            "fax_number": "423-778-9301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 E 3RD ST",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374032241",
            "telephone_number": "423-778-9300",
            "fax_number": "423-778-9301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DASSOW",
        "first_name": "PAUL",
        "middle_name": "LARRY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2012-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "34878",
            "primary": true
        },
        {
            "code": "207QA0000X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adolescent Medicine",
            "state": "KY",
            "license": "34878",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "KY",
            "license": "34878",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "KY",
            "license": "34878",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64348782",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chattanooga, TN

Sources for this page

Verify at the official NPI Registry.