Active NPI
John H. Dirckx
- General Practice Physician
- Dayton, OH
National Provider Identifier
1063737815
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 35.027266
- Practice address
- 260 Ravelle CT
Dayton, OH 45420-1894 - Phone
- (937) 258-0499
- NPI assigned
- Apr 5, 2010
- Last updated
- Apr 5, 2010
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 35.027266 | OH | Primary |
Addresses
Primary practice location
260 Ravelle CT
Dayton, OH 45420-1894
Mailing address
260 Ravelle CT
Dayton, OH 45420-1894
Phone (937) 258-0499
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35.027266 | OH | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1270425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270425600000",
"number": "1063737815",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "260 RAVELLE CT",
"city": "DAYTON",
"state": "OH",
"postal_code": "454201894",
"telephone_number": "937-258-0499"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "260 RAVELLE CT",
"city": "DAYTON",
"state": "OH",
"postal_code": "454201894",
"telephone_number": "937-258-0499"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIRCKX",
"first_name": "JOHN",
"middle_name": "H.",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-04-05",
"last_updated": "2010-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "OH",
"license": "35.027266",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dayton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.