Organization Active NPI

Internal Medicine Physicians of Central Ohio LLC

  • Internal Medicine Physician
  • Marysville, OH
National Provider Identifier
1043300031
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
INTERNAL MEDICINE PHYSICIANS OF CENTRAL OHIO LLC
Practice address
660 London Ave
Suite a
Marysville, OH 43040-1515
Phone
(937) 642-1550
Fax
(937) 578-2717
NPI assigned
Oct 13, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Prasanna K Muniyappa, M.D.NPI 1689667594
Title
Physician Member
Phone
(937) 642-1550

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

660 London Ave
Suite a
Marysville, OH 43040-1515

Mailing address

660 London Ave
Suite a
Marysville, OH 43040-1515
Phone (937) 642-1550

Other identifiers 1

IdentifierTypeStateIssuer
2565282MedicaidOH

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D1030682Internal Medicine Physicians of660 London Ave Suite a, Marysville, OH 43040Certificate of waiverSep 12, 2026

National Provider Directory

National Provider Directory

Locations

660 London Ave
Ste A
Marysville, OH 43040
Phone (937) 578-4206

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043300031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 LONDON AVE",
            "address_2": "SUITE A",
            "city": "MARYSVILLE",
            "state": "OH",
            "postal_code": "430401515",
            "telephone_number": "937-642-1550",
            "fax_number": "937-578-2717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 LONDON AVE",
            "address_2": "SUITE A",
            "city": "MARYSVILLE",
            "state": "OH",
            "postal_code": "430401515",
            "telephone_number": "937-642-1550",
            "fax_number": "937-578-2717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE PHYSICIANS OF CENTRAL OHIO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MUNIYAPPA",
        "authorized_official_first_name": "PRASANNA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PHYSICIAN MEMBER",
        "authorized_official_telephone_number": "937-642-1550",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2565282",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marysville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.