Active NPI
Christian J Baddour, DO
- Diagnostic Radiology Physician
- Mansfield, OH
National Provider Identifier
1053475228
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 34006375
- Practice address
- 1456 Park Ave W Ste M
Mansfield, OH 44906-2700 - Phone
- (419) 529-1471
- Fax
- (419) 529-1473
- NPI assigned
- Dec 21, 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 |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 34006375 | OH | Primary |
Addresses
Primary practice location
1456 Park Ave W Ste M
Mansfield, OH 44906-2700
Mailing address
1456 Park Ave W Ste M
Mansfield, OH 44906-2700
Phone (419) 529-1471
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000162607 | Other | OH | ANTHEM |
| 2015036 | 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 Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34006375 | OH | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Preventive Diagnostics 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.
-
- Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
- Columbus, OH
- NPI 1316254857
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1053475228",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1456 PARK AVE W STE M",
"city": "MANSFIELD",
"state": "OH",
"postal_code": "449062700",
"telephone_number": "419-529-1471",
"fax_number": "419-529-1473"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1456 PARK AVE W STE M",
"city": "MANSFIELD",
"state": "OH",
"postal_code": "449062700",
"telephone_number": "419-529-1471",
"fax_number": "419-529-1473"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BADDOUR",
"first_name": "CHRISTIAN",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-21",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "OH",
"license": "34006375",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000162607",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2015036",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mansfield, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.