NPIMap

Organization Active NPI

Healthy Life Center LLC

  • Family Medicine Physician
  • Reynoldsburg, OH
National Provider Identifier
1003511627
Registry record updated Apr 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
HEALTHY LIFE CENTER LLC
Practice address
1612 Lancaster Ave Ste B
Reynoldsburg, OH 43068-2639
Phone
(614) 599-3800
NPI assigned
Apr 3, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2023

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

Authorized official

Name
Pavan Venkata DontineniNPI 1790944866
Title
Owner
Phone
(740) 877-0478

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1612 Lancaster Ave Ste B
Reynoldsburg, OH 43068-2639

Mailing address

1612 Lancaster Ave Ste B
Reynoldsburg, OH 43068-2639

National Provider Directory

National Provider Directory

Locations

1612 Lancaster Ave
Ste B
Reynoldsburg, OH 43068
Phone (614) 599-3800

Practitioners & affiliated clinicians

Practitioners 1

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": "1680480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682294400000",
    "number": "1003511627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1612 LANCASTER AVE STE B",
            "city": "REYNOLDSBURG",
            "state": "OH",
            "postal_code": "430682639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1612 LANCASTER AVE STE B",
            "city": "REYNOLDSBURG",
            "state": "OH",
            "postal_code": "430682639",
            "telephone_number": "614-599-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHY LIFE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-03",
        "last_updated": "2023-04-24",
        "certification_date": "2023-04-24",
        "status": "A",
        "authorized_official_last_name": "DONTINENI",
        "authorized_official_first_name": "PAVAN",
        "authorized_official_middle_name": "VENKATA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "740-877-0478"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reynoldsburg, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.