Active NPI
Driss Ben H Cammoun, MD
- Diagnostic Radiology Physician
- Waterloo, IA
National Provider Identifier
1912950304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 27297
- Practice address
- 4006 Johnathan St
Waterloo, IA 50701-9395 - Phone
- (319) 236-2700
- Fax
- (319) 236-2714
- NPI assigned
- May 18, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 27297 | IA | Primary |
Addresses
Primary practice location
4006 Johnathan St
Waterloo, IA 50701-9395
Mailing address
PO Box 2758
Waterloo, IA 50704-2758
Phone (319) 235-3716
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42141730794 | Other | IA | JOHN DEERE HEALTH INS P |
| 1064758 | Medicaid | IA | |
| 56254 | Other | IA | WELLMARK INS PLAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27297 | IA | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190592000000",
"number": "1912950304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2758",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507042758",
"telephone_number": "319-235-3716",
"fax_number": "319-233-1630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4006 JOHNATHAN ST",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507019395",
"telephone_number": "319-236-2700",
"fax_number": "319-236-2714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAMMOUN",
"first_name": "DRISS",
"middle_name": "BEN H",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-18",
"last_updated": "2007-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "IA",
"license": "27297",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "JOHN DEERE HEALTH INS P",
"identifier": "42141730794",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1064758",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLMARK INS PLAN",
"identifier": "56254",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waterloo, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.