Individual provider Active NPI

Damian Ivan Lebamoff, MD

  • Surgery Physician
  • Dayton, OH
National Provider Identifier
1831163518
Registry record updated May 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
35070091 Issued in OH
Practice address
3737 Southern Blvd Ste 2000
Dayton, OH 45429-1285
Phone
(937) 228-4126
Fax
(937) 228-0247
NPI assigned
Feb 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 35070091 OH
Surgery Physician 208600000X 35070091 OH Primary

Addresses

Primary practice location

3737 Southern Blvd Ste 2000
Dayton, OH 45429-1285

Mailing address

1 Prestige PL Ste 550
Miamisburg, OH 45342-6115
Phone (937) 762-1310

Other identifiers 1

IdentifierTypeStateIssuer
0241974MedicaidOH

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address dlebamoff178334@direct.ketteringhealth.org
FHIR URL https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20100202000220 OH Practitioner - General SurgeryPractitioner - Vascular Surgery 2062448632 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General SurgeryAlso: Vascular Surgery
Education
Wright State University Boonshoft School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kettering Independent Medical Group IncGroup PAC ID 3173710936, 699 clinicians

Practice addresses (Care Compare)

3535 Southern Blvd
Kettering, OH 45429-1221
Phone (937) 395-8646

3737 Southern Blvd
Kettering, OH 45429-1285

4403 Far Hills Ave
Kettering, OH 45429-2405
Phone (937) 433-5309

4441 Far Hills Ave
Kettering, OH 45429-2405
Phone (937) 298-7751

Hospital & facility affiliations

  • Kettering Health Main Campus Hospital, Kettering, OH, CCN 360079
  • Kettering Health Dayton Hospital, Dayton, OH, CCN 360133
  • Miami Valley Hospital Hospital, Dayton, OH, CCN 360051
  • Soin Medical Center Hospital, Beaver Creek, OH, CCN 360360
  • Kettering Health Troy Hospital, Troy, OH, CCN 360368

Merit-based Incentive Payment System (MIPS)

Final score
81.34 of 100Reported as group
Quality
63.67
Promoting interoperability
100
Improvement activities
40
Cost
74.14

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion39
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35070091OHMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kettering Independent Medical Group Inc Surgery CurrentSince Dec 29, 2022 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

3535 Pentagon Blvd
Ste 330
Beavercreek, OH 45431
Phone (937) 558-3021

1 Elizabeth Pl
Ste 10A
Dayton, OH 45417
Phone (937) 224-7341

3737 Southern Blvd
Ste 2000
Kettering, OH 45429
Phone (937) 228-4126

4403 Far Hills Ave
Kettering, OH 45429
Phone (937) 395-3910

4000 Miamisburg Centerville Rd
Ste 435
Miamisburg, OH 45342
Phone (937) 384-4511

1 Prestige Pl
Ste 550
Miamisburg, OH 45342
Phone (937) 752-2306

6147 State Route 122
Ste 110
Middletown, OH 45005
Phone (513) 260-3500

70 Weller Dr
Tipp City, OH 45371
Phone (937) 298-4417

70 Weller Dr
Ste 100
Tipp City, OH 45371
Phone (937) 667-0400

Organizations & group practices 2

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.

Hospital & facility affiliations 5

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": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620259200000",
    "number": "1831163518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PRESTIGE PL STE 550",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453426115",
            "telephone_number": "937-762-1310",
            "fax_number": "937-522-8068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3737 SOUTHERN BLVD STE 2000",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454291285",
            "telephone_number": "937-228-4126",
            "fax_number": "937-228-0247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEBAMOFF",
        "first_name": "DAMIAN",
        "middle_name": "IVAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-17",
        "last_updated": "2021-05-06",
        "certification_date": "2021-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "OH",
            "license": "35070091",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "35070091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0241974",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dlebamoff178334@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "One Elizabeth Place",
            "address_2": "Suite 10 A",
            "city": "Dayton",
            "state": "OH",
            "country_code": "US",
            "postal_code": "45408",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "One Elizabeth Place",
            "address_2": "Suite 10 A",
            "city": "Dayton",
            "state": "OH",
            "country_code": "US",
            "postal_code": "45408",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.