NPIMap

Organization Active NPI

Mary Rutan Hospital

Doing business as Mad River Family Practice

  • Family Medicine Physician
  • West Liberty, OH
National Provider Identifier
1003875949
Registry record updated Jul 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MARY RUTAN HOSPITAL
Doing business as
Mad River Family Practice
Practice address
4879 US Highway 68 S
West Liberty, OH 43357-9525
Phone
(937) 599-1411
Fax
(937) 465-9945
NPI assigned
Mar 20, 2006
Last updated
Jul 10, 2007By the provider in NPPES
Organization subpart
Yes
Parent organization
MARY RUTAN HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 10, 2007

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

Authorized official

Name
Ron Carmin
Title
VP/Finance
Phone
(937) 592-4015

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

4879 US Highway 68 S
West Liberty, OH 43357-9525

Mailing address

4879 US Highway 68 S
West Liberty, OH 43357-9525
Phone (937) 599-1411

Other identifiers 1

IdentifierTypeStateIssuer
2055332MedicaidOH

Other names 1

  • Mad River Family Practice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031124000531 OH Part B Supplier - Clinic/Group Practice 9032013792 Receives reassigned benefits from 132 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bellefontaine, OH; Waynesfield, OH; Urbana, OH; Saint Paris, OH; Russells Point, OH; Lima, OH; Lakeview, OH; Kenton, OH…

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Madriver Family Pract

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 331

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 331

NPI Registry JSON

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

{
    "created_epoch": "1142812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184025600000",
    "number": "1003875949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4879 US HIGHWAY 68 S",
            "city": "WEST LIBERTY",
            "state": "OH",
            "postal_code": "433579525",
            "telephone_number": "937-599-1411",
            "fax_number": "937-465-9945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4879 US HIGHWAY 68 S",
            "city": "WEST LIBERTY",
            "state": "OH",
            "postal_code": "433579525",
            "telephone_number": "937-599-1411",
            "fax_number": "937-465-9945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY RUTAN HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARY RUTAN HOSPITAL",
        "enumeration_date": "2006-03-20",
        "last_updated": "2007-07-10",
        "status": "A",
        "authorized_official_last_name": "CARMIN",
        "authorized_official_first_name": "RON",
        "authorized_official_title_or_position": "VP/FINANCE",
        "authorized_official_telephone_number": "937-592-4015"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2055332",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mad River Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Liberty, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.