NPIMap

Organization Active NPI

A Reza Miremadi MD DDS LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Springboro, OH
National Provider Identifier
1053597930
Registry record updated Jan 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
A REZA MIREMADI MD DDS LLC
Practice address
576 N Main St
Springboro, OH 45066-9552
Phone
(937) 748-8814
Fax
(937) 748-8817
NPI assigned
Jan 10, 2008
Last updated
Jan 9, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2014

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

Authorized official

Name
Cindy Laymaster
Title
Financial Manager
Phone
(937) 748-8814

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223S0112X Primary
Oral & Maxillofacial Surgery (D.M.D.)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 204E00000X

Addresses

Primary practice location

576 N Main St
Springboro, OH 45066-9552

Mailing address

576 N Main St
Springboro, OH 45066-9552
Phone (937) 748-8814

Other identifiers 1

IdentifierTypeStateIssuer
2421132MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051208000580 OH Part B Supplier - Clinic/Group Practice 9931120771 Receives reassigned benefits from 3 practitioners
Practice locations: Springboro, OH

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
36D2000155A Reza Miremadi MD DDS LLC576 North Main Street, Springboro, OH 45066Certificate of waiverNov 19, 2027

National Provider Directory

National Provider Directory

Locations

576 N Main St
Springboro, OH 45066
Phone (937) 748-8814

Practitioners & affiliated clinicians

Practitioners 7

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": "1199923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389225600000",
    "number": "1053597930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "576 N MAIN ST",
            "city": "SPRINGBORO",
            "state": "OH",
            "postal_code": "450669552",
            "telephone_number": "937-748-8814",
            "fax_number": "937-748-8817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "576 N MAIN ST",
            "city": "SPRINGBORO",
            "state": "OH",
            "postal_code": "450669552",
            "telephone_number": "937-748-8814",
            "fax_number": "937-748-8817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A REZA MIREMADI MD DDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-10",
        "last_updated": "2014-01-09",
        "status": "A",
        "authorized_official_last_name": "LAYMASTER",
        "authorized_official_first_name": "CINDY",
        "authorized_official_title_or_position": "FINANCIAL MANAGER",
        "authorized_official_telephone_number": "937-748-8814"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2421132",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springboro, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.