Active NPI
Shana Lynette Mundy
- Preferred Provider Organization
- Springfield, OH
National Provider Identifier
1023605862
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Preferred Provider Organization
- Practice address
- 345 Larchmont Ave
Springfield, OH 45503-5423 - Phone
- (937) 631-5017
- NPI assigned
- Dec 28, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Preferred Provider Organization | 305R00000X | Primary |
Addresses
Primary practice location
345 Larchmont Ave
Springfield, OH 45503-5423
Mailing address
345 Larchmont Ave
Springfield, OH 45503-5423
Phone (937) 631-5017
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1203629 | Medicaid | OH |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609113600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609113600000",
"number": "1023605862",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "345 LARCHMONT AVE",
"city": "SPRINGFIELD",
"state": "OH",
"postal_code": "455035423",
"telephone_number": "937-631-5017"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "345 LARCHMONT AVE",
"city": "SPRINGFIELD",
"state": "OH",
"postal_code": "455035423",
"telephone_number": "937-631-5017"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUNDY",
"first_name": "SHANA",
"middle_name": "LYNETTE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-12-28",
"last_updated": "2020-12-28",
"certification_date": "2020-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "305R00000X",
"taxonomy_group": "",
"desc": "Preferred Provider Organization",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1203629",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Springfield, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.