NPIMap

Organization Active NPI

Healthsource of Ohio Inc

  • Federally Qualified Health Center (FQHC)
  • Batavia, OH
National Provider Identifier
1013428200
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HEALTHSOURCE OF OHIO INC
Practice address
1341 Clough Pike
Batavia, OH 45103-2503
Phone
(513) 732-5085
Fax
(513) 214-2408
NPI assigned
Oct 16, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

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

Authorized official

Name
Joseph W Prather II, MD
Title
Ceo
Phone
(513) 707-4041

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1341 Clough Pike
Batavia, OH 45103-2503

Mailing address

424 Wards Corner Rd Ste 200
Loveland, OH 45140-6966
Phone (513) 707-4041

Other identifiers 1

IdentifierTypeStateIssuer
0260605MedicaidOH

Other names 1

  • HealthSource: West Clermont Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180614002524 OH Part A Provider - Federally Qualified Health Center (FQHC) 2264328749 Practice locations: Batavia, OH

Federally qualified health center certification: CCN 361170

Legal name
HEALTHSOURCE OF OHIO, INC.
Doing business as
HEALTHSOURCE: WEST CLERMONT
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 12, 2018
Last certification
Jun 12, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1976 in OH
Enrollment address
1341 Clough Pike
Batavia, OH 45103-2503

Other NPIs with the same Medicare PAC ID 24

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 24

National Provider Directory

National Provider Directory
Tax ID family
West Union Family Healt45 organizations share this tax ID, including this one

Other organizations with this tax ID 44

Organizations that report the same tax identification number in the National Provider Directory.

View all 44

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Gail Koford Individual Corporate DirectorBoard Member May 28, 2024
Douglas McDonald Individual Corporate DirectorBoard Member Jan 25, 2021
Patrick Hayes Individual Corporate DirectorBoard Member Jan 30, 2025
Stephen Hood Individual Corporate DirectorBoard Member Mar 31, 2022
Joseph W Prather Individual Corporate OfficerCeo May 28, 2024
W-2 Managing EmployeeCeo May 28, 2024
Tiffany Mattingly Individual Corporate DirectorBoard Member Apr 28, 2022
Mark McAndrew Individual Corporate DirectorBoard Member May 25, 2017
Jina L Bohl Individual Corporate DirectorBoard Member Mar 28, 2019
Konstantinos Elefter Individual Corporate DirectorBoard Member Dec 10, 2020
Cynthia L. Wright Sellers Individual Corporate DirectorBoard Member Jun 29, 2017

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Healthsource Batavia Family PracticeBatavia, OH, CCN 361820 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 1976

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1508112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726617600000",
    "number": "1013428200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 WARDS CORNER RD STE 200",
            "city": "LOVELAND",
            "state": "OH",
            "postal_code": "451406966",
            "telephone_number": "513-707-4041",
            "fax_number": "513-576-1020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1341 CLOUGH PIKE",
            "city": "BATAVIA",
            "state": "OH",
            "postal_code": "451032503",
            "telephone_number": "513-732-5085",
            "fax_number": "513-214-2408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHSOURCE OF OHIO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-16",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A",
        "authorized_official_last_name": "PRATHER II",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "513-707-4041",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0260605",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HealthSource: West Clermont",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Batavia, OH

Sources for this page

Verify at the official NPI Registry.