NPIMap

Organization Active NPI

Premier Integrated Medical Assoc LTD

  • Pediatrics Physician
  • Beavercreek, OH
National Provider Identifier
1023075330
Registry record updated Jul 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PREMIER INTEGRATED MEDICAL ASSOC LTD
Practice address
2322 Lakeview Dr
Beavercreek, OH 45431
Phone
(937) 320-3848
Fax
(937) 320-3848
NPI assigned
Apr 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2019

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

Authorized official

Name
Dr. Mark A Couch, MDNPI 1548224314
Title
President
Phone
(937) 898-3600

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary
Pediatric Adolescent Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080A0000X

Addresses

Primary practice location

2322 Lakeview Dr
Beavercreek, OH 45431

Mailing address

25 Merchant St
Ste 220 - Attn Credentialing
Cincinnati, OH 45246-3740
Phone (513) 533-1199

Other identifiers 2

IdentifierTypeStateIssuer
2106232MedicaidOH
CA2478OtherOHMEDICARE RR ID

Other names 1

  • PriMed Physicians Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Premier Integrated Medi7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

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": "1146182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563148800000",
    "number": "1023075330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 MERCHANT ST",
            "address_2": "STE 220 - ATTN CREDENTIALING",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452463740",
            "telephone_number": "513-533-1199",
            "fax_number": "513-645-9827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2322 LAKEVIEW DR",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "45431",
            "telephone_number": "937-320-3848",
            "fax_number": "937-320-3848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER INTEGRATED MEDICAL ASSOC LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-28",
        "last_updated": "2019-07-15",
        "status": "A",
        "authorized_official_last_name": "COUCH",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "937-898-3600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2106232",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR ID",
            "identifier": "CA2478",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PriMed Physicians",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PriMed Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beavercreek, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2019; 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.