Samantha Rae Didomenico, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

202930 Issued in CO

Practice address

245 Vine Ave
Las Animas, CO 81054

Phone

(719) 456-2653

NPI assigned

Sep 1, 2016

Last updated

Jun 5, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Samantha Rae Smith Former name

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Peak Vista Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Colorado Springs, CO
  • NPI 1730166034
  Medicare reassignment NPD
• Peak Vista Community Health Centers

  dba Behavioral Health at Inside Out Youth Services

  • Federally Qualified Health Center (FQHC)
  • Colorado Springs, CO
  • NPI 1871347443
  NPD

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

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528156800000",
    "number": "1891241527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1119 W 11TH ST",
            "city": "LA JUNTA",
            "state": "CO",
            "postal_code": "810502608",
            "telephone_number": "972-672-4468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 VINE AVE",
            "city": "LAS ANIMAS",
            "state": "CO",
            "postal_code": "81054",
            "telephone_number": "719-456-2653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIDOMENICO",
        "first_name": "SAMANTHA",
        "middle_name": "RAE",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-01",
        "last_updated": "2018-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "202930",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "SMITH",
            "middle_name": "RAE",
            "credential": "D.D.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bent County Public Health
• Bent County Public Health
• Colorado Coalition for the Homeless (Ft. Lyon)
• County of Bent School District Re-1
• Shelby D Davis
• Karen L Donkle, NP
• Cassie Lane Elder, RN
• Family Medical Services
• Steven Gallegos, ACNP/FNP-BC
• Lidia Gonzalez

• General Practice Dentistry in Las Animas, CO
• Providers in Las Animas, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.