Organization Active NPI

Southern Ohio Recovery Group, Inc

  • Addiction Medicine (Family Medicine) Physician
  • Blue Ash, OH
National Provider Identifier
1043739196
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X
Legal business name
SOUTHERN OHIO RECOVERY GROUP, INC
Practice address
9403 Kenwood Rd
Blue Ash, OH 45242-6895
Phone
(513) 543-6600
NPI assigned
Sep 10, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Rachele Smith
Title
Practice Manager
Phone
(513) 377-9374

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Family Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QA0401X Primary

Addresses

Primary practice location

9403 Kenwood Rd
Blue Ash, OH 45242-6895

Mailing address

9403 Kenwood Rd
Blue Ash, OH 45242-6895
Phone (513) 543-6600

Other practice location 1

1592 Goodman Ave
Cincinnati, OH 45224-1005
Phone (513) 522-7246

Other practice location 2

950 E Alex Bell Rd # Ll
Centerville, OH 45459-2721
Phone (937) 291-2300

Other identifiers 1

IdentifierTypeStateIssuer
31094333MedicaidOH

National Provider Directory

National Provider Directory

Locations

1592 Goodman Ave
Cincinnati, OH 45224
Phone (513) 522-7246

Practitioners & affiliated clinicians

Practitioners 5

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": "1505001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1043739196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9403 KENWOOD RD",
            "city": "BLUE ASH",
            "state": "OH",
            "postal_code": "452426895",
            "telephone_number": "513-543-6600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9403 KENWOOD RD",
            "city": "BLUE ASH",
            "state": "OH",
            "postal_code": "452426895",
            "telephone_number": "513-543-6600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1592 Goodman Ave",
            "address_purpose": "LOCATION",
            "city": "Cincinnati",
            "state": "OH",
            "postal_code": "452241005",
            "country_code": "US",
            "telephone_number": "513-522-7246",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "950 E Alex Bell Rd # Ll",
            "address_purpose": "LOCATION",
            "city": "Centerville",
            "state": "OH",
            "postal_code": "454592721",
            "country_code": "US",
            "telephone_number": "937-291-2300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHERN OHIO RECOVERY GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-10",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "RACHELE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "513-377-9374"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31094333",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blue Ash, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.