NPIMap

Organization Active NPI

Premier Integreated Medical Assoc LTD

Doing business as PriMed Physicians

  • Family Medicine Physician
  • Centerville, OH
National Provider Identifier
1073570370
Registry record updated Jan 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PREMIER INTEGREATED MEDICAL ASSOC LTD
Doing business as
PriMed Physicians
Practice address
979 Congress Park Dr
Centerville, OH 45459-4009
Phone
(937) 435-9013
Fax
(937) 435-1458
NPI assigned
Apr 28, 2006
Last updated
Jan 4, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2010

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

Authorized official

Name
Dr. Mark A Couch, MDNPI 1548224314
Title
President
Phone
(937) 898-3600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

979 Congress Park Dr
Centerville, OH 45459-4009

Mailing address

4700 Smith Rd
Suite a
Cincinnati, OH 45212-2787
Phone (513) 619-6819

Other identifiers 1

IdentifierTypeStateIssuer
0115342MedicaidOH

Other names 1

  • PriMed Physicians Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040409000393 OH Part B Supplier - Clinic/Group Practice 9032101399 Receives reassigned benefits from 27 practitioners
19 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dayton, OH; Kettering, OH; Englewood, OH; Beavercreek, OH

Other NPIs on the same Medicare enrollment 19

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 19

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1146182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262563200000",
    "number": "1073570370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 SMITH RD",
            "address_2": "SUITE A",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452122787",
            "telephone_number": "513-619-6819",
            "fax_number": "513-645-2393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "979 CONGRESS PARK DR",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454594009",
            "telephone_number": "937-435-9013",
            "fax_number": "937-435-1458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER INTEGREATED MEDICAL ASSOC LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-28",
        "last_updated": "2010-01-04",
        "status": "A",
        "authorized_official_last_name": "COUCH",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "937-898-3600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0115342",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PriMed Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Centerville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2010; 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.