Individual provider Active NPI

Thomas Jerome Bach, MS, LICDC-CS

  • Addiction (Substance Use Disorder) Counselor
  • Cincinnati, OH
National Provider Identifier
1003571985
Registry record updated Nov 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
LICDC.965593 Issued in OH
Practice address
1617 Reading Rd
Cincinnati, OH 45202-1413
Phone
(513) 563-2366
Fax
(513) 629-2311
NPI assigned
Nov 4, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X LICDC.965593 OH Primary

Addresses

Primary practice location

1617 Reading Rd
Cincinnati, OH 45202-1413

Mailing address

3678 Jessup Rd
Cincinnati, OH 45247-6032
Phone (513) 390-5497

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)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
LICDC.965593OHMDAddiction (Substance Use Disorder) Counselor

NPI Registry JSON

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

{
    "created_epoch": "1635984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635984000000",
    "number": "1003571985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3678 JESSUP RD",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452476032",
            "telephone_number": "513-390-5497",
            "fax_number": "513-629-2311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1617 READING RD",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452021413",
            "telephone_number": "513-563-2366",
            "fax_number": "513-629-2311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACH",
        "first_name": "THOMAS",
        "middle_name": "JEROME",
        "credential": "MS, LICDC-CS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-04",
        "last_updated": "2021-11-04",
        "certification_date": "2021-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "LICDC.965593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2021; 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.