Active NPI
Robert J McConnell, D.O.
- Geriatric Medicine (Family Medicine) Physician
- Vandalia, OH
National Provider Identifier
1053393934
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Medicine (Family Medicine) Physician
- License
- OH34001569
- Practice address
- 107 Kenbrook Dr
Vandalia, OH 45377-2427 - Phone
- (937) 890-1725
- Fax
- (937) 890-1725
- NPI assigned
- Nov 16, 2005
- 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 |
|---|---|---|---|---|
| Geriatric Medicine (Family Medicine) Physician | 207QG0300X | OH34001569 | OH | Primary |
Addresses
Primary practice location
107 Kenbrook Dr
Vandalia, OH 45377-2427
Mailing address
P.O. Box 235
Vandalia, OH 45377-2427
Phone (937) 890-1725
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010047653 | Other | OH | RAILROAD MEDICARE |
| 000000003522 | Other | OH | BC/BS |
| 0020391 | Medicaid | OH | |
| A14298 | Other | OH | UPIN |
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 Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OH34001569 | OH | MD | Geriatric Medicine (Family Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lima Memorial Joint Operating Company | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Geriatric Medicine (Internal Medicine) Physician
- Vandalia, OH
- NPI 1750570164
-
dba Lima Memorial Health System
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1053393934",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 235",
"city": "VANDALIA",
"state": "OH",
"postal_code": "453772427",
"telephone_number": "937-890-1725",
"fax_number": "937-890-1725"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "107 KENBROOK DR",
"city": "VANDALIA",
"state": "OH",
"postal_code": "453772427",
"telephone_number": "937-890-1725",
"fax_number": "937-890-1725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCONNELL",
"first_name": "ROBERT",
"middle_name": "J",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-16",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "207QG0300X",
"taxonomy_group": "",
"desc": "Family Medicine, Geriatric Medicine",
"state": "OH",
"license": "OH34001569",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "010047653",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "000000003522",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0020391",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UPIN",
"identifier": "A14298",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vandalia, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.