Individual provider Active NPI

Lauren Dome, RN/NP

  • Pediatric Nurse Practitioner
  • Rockville, MD
National Provider Identifier
1992782627
Registry record updated Dec 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
R121173 Issued in MD
Practice address
9715 Medical Center Dr
Suite 414
Rockville, MD 20850
Phone
(240) 826-6588
Fax
(301) 217-9303
NPI assigned
Dec 23, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X R121173 MD Primary

Addresses

Primary practice location

9715 Medical Center Dr
Suite 414
Rockville, MD 20850

Mailing address

11206 Welland St
North Potomac, MD 20878
Phone (301) 424-3017

Other identifiers 1

IdentifierTypeStateIssuer
1992782627MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111011000234 DC Practitioner - Nurse Practitioner 3476725797 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
R121173MDMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Hospital Current Accepting new patients
Children'S Hospital CurrentSince Oct 15, 2012 Accepting new patients
Children'S Hospital CurrentSince Oct 15, 2012 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

111 Michigan Ave NW
Washington, DC 20010
Phone (202) 476-3670

900 23rd St NW
Washington, DC 20037
Phone (202) 715-4750

9901 Medical Center Dr
Rockville, MD 20850
Phone (301) 279-6000

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1135296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545782400000",
    "number": "1992782627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11206 WELLAND ST",
            "city": "NORTH POTOMAC",
            "state": "MD",
            "postal_code": "20878",
            "telephone_number": "301-424-3017",
            "fax_number": "240-826-6580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9715 MEDICAL CENTER DR",
            "address_2": "SUITE 414",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "20850",
            "telephone_number": "240-826-6588",
            "fax_number": "301-217-9303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOME",
        "first_name": "LAUREN",
        "credential": "RN/NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-23",
        "last_updated": "2018-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MD",
            "license": "R121173",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992782627",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville, MD

Sources for this page

Verify at the official NPI Registry.