Active NPI
J Kelley Brennan, MD
- Internal Medicine Physician
- Columbus, OH
National Provider Identifier
1043261316
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 35033636B
- Practice address
- 5969 East Broad Street
2ND Floor
Columbus, OH 43213 - Phone
- (614) 864-6010
- Fax
- (614) 864-0306
- NPI assigned
- May 12, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 35033636B | OH | Primary |
Addresses
Primary practice location
5969 East Broad Street
2ND Floor
Columbus, OH 43213
Mailing address
5969 East Broad Street
2ND Floor
Columbus, OH 43213
Phone (614) 864-6010
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0454119 | 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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35033636B | OH | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Radiology Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Diagnostic Radiology Physician
- Dublin, OH
- NPI 1609865708
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347321600000",
"number": "1043261316",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5969 EAST BROAD STREET",
"address_2": "2ND FLOOR",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "43213",
"telephone_number": "614-864-6010",
"fax_number": "614-864-0306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5969 EAST BROAD STREET",
"address_2": "2ND FLOOR",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "43213",
"telephone_number": "614-864-6010",
"fax_number": "614-864-0306"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRENNAN",
"first_name": "J",
"middle_name": "KELLEY",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-12",
"last_updated": "2012-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "OH",
"license": "35033636B",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0454119",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.