Organization Active NPI

Midwest Internal Medicine Associates LLC

  • Internal Medicine Physician
  • Marion, OH
National Provider Identifier
1003001538
Registry record updated Oct 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35056082 Issued in OH
Legal business name
MIDWEST INTERNAL MEDICINE ASSOCIATES LLC
Practice address
1728 Marion Waldo Rd
Marion, OH 43302-7457
Phone
(740) 389-2297
Fax
(740) 389-2427
NPI assigned
Sep 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2020

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

Authorized official

Name
Mrs. Kelly S Ratliff
Title
Billing Cordinator
Phone
(740) 616-8052

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X 35056082 OH Primary

Addresses

Primary practice location

1728 Marion Waldo Rd
Marion, OH 43302-7457

Mailing address

1728 Marion Waldo Rd
Marion, OH 43302-7457
Phone (740) 389-2297

Other identifiers 1

IdentifierTypeStateIssuer
2156143MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050915000905 OH Part B Supplier - Clinic/Group Practice 4587697974 Receives reassigned benefits from 7 practitioners
Practice locations: Marion, OH

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D0330599Midwest Internal Medicine Associates1728 Marion Waldo Road, Marion, OH 43302Certificate of waiverApr 27, 2028

National Provider Directory

National Provider Directory

Locations

970 S Prospect St
Marion, OH 43302
Phone (740) 382-9293

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1189123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603929600000",
    "number": "1003001538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1728 MARION WALDO RD",
            "city": "MARION",
            "state": "OH",
            "postal_code": "433027457",
            "telephone_number": "740-389-2297",
            "fax_number": "740-389-2427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1728 MARION WALDO RD",
            "city": "MARION",
            "state": "OH",
            "postal_code": "433027457",
            "telephone_number": "740-389-2297",
            "fax_number": "740-389-2427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST INTERNAL MEDICINE ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-07",
        "last_updated": "2020-10-29",
        "certification_date": "2020-10-29",
        "status": "A",
        "authorized_official_last_name": "RATLIFF",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "BILLING CORDINATOR",
        "authorized_official_telephone_number": "740-616-8052",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35056082",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2156143",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marion, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.