NPIMap

Organization Active NPI

Capital City Regenerative Medicine LLC

  • Family Medicine Physician
  • Worthington, OH
National Provider Identifier
1023620879
Registry record updated Oct 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CAPITAL CITY REGENERATIVE MEDICINE LLC
Practice address
5577 N High St Ste B
Worthington, OH 43085-3939
Phone
(614) 436-3870
NPI assigned
Aug 21, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2021

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

Authorized official

Name
Brian Schuetz
Title
Authorized Official
Phone
(614) 436-3870

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

5577 N High St Ste B
Worthington, OH 43085-3939

Mailing address

5577 N High St Ste B
Worthington, OH 43085-3939
Phone (614) 436-3870

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201022002639 OH Part B Supplier - Clinic/Group Practice 6103246616 Receives reassigned benefits from 3 practitioners
Practice locations: Worthington, OH

National Provider Directory

National Provider Directory

Locations

5577 N High St
Ste A
Worthington, OH 43085
Phone (614) 436-3870

Practitioners & affiliated clinicians

Practitioners 11

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": "1597968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634083200000",
    "number": "1023620879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5577 N HIGH ST STE B",
            "city": "WORTHINGTON",
            "state": "OH",
            "postal_code": "430853939",
            "telephone_number": "614-436-3870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5577 N HIGH ST STE B",
            "city": "WORTHINGTON",
            "state": "OH",
            "postal_code": "430853939",
            "telephone_number": "614-436-3870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPITAL CITY REGENERATIVE MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-21",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A",
        "authorized_official_last_name": "SCHUETZ",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "614-436-3870"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worthington, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2021; 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.