NPIMap

Organization Active NPI

Ketamine Health & Wellness Clinics of Ohio LLC

  • Psychiatry Physician
  • Dublin, OH
National Provider Identifier
1053005116
Registry record updated Jan 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
KETAMINE HEALTH & WELLNESS CLINICS OF OHIO LLC
Practice address
5060 Bradenton Ave Ste a
Dublin, OH 43017-3511
Phone
(380) 214-1636
Fax
(380) 235-7469
NPI assigned
Jun 2, 2023
Last updated
Jan 14, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2025

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

Authorized official

Name
Dr. Brian S Seifferth, MDNPI 1205887320
Title
President
Phone
(614) 306-1073

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
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

5060 Bradenton Ave Ste a
Dublin, OH 43017-3511

Mailing address

5060 Bradenton Ave Ste a
Dublin, OH 43017-3511
Phone (380) 214-1636

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250221003200 OH Part B Supplier - Clinic/Group Practice 0446770341 Receives reassigned benefits from 6 practitioners
Practice locations: Dublin, OH

National Provider Directory

National Provider Directory

Locations

5060 Bradenton Ave
Ste A
Dublin, OH 43017
Phone (380) 214-1636

Practitioners & affiliated clinicians

Practitioners 11

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": "1685664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736812800000",
    "number": "1053005116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5060 BRADENTON AVE STE A",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430173511",
            "telephone_number": "380-214-1636",
            "fax_number": "380-235-7469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5060 BRADENTON AVE STE A",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430173511",
            "telephone_number": "380-214-1636",
            "fax_number": "380-235-7469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAMINE HEALTH & WELLNESS CLINICS OF OHIO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-02",
        "last_updated": "2025-01-14",
        "certification_date": "2025-01-14",
        "status": "A",
        "authorized_official_last_name": "SEIFFERTH",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "614-306-1073",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dublin, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2025; 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.