Individual provider Active NPI

Maury Witkoff, D.O.

  • Emergency Medicine Physician
  • Columbus, OH
National Provider Identifier
1073591657
Registry record updated Feb 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
34-005979 Issued in OH
Practice address
6001 E Broad St
Columbus, OH 43213
Phone
(614) 224-6420
NPI assigned
Jan 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 34-005979 OH Primary

Addresses

Primary practice location

6001 E Broad St
Columbus, OH 43213

Mailing address

2376 Village at Bexley Dr
Columbus, OH 43209-2896
Phone (614) 402-3668

Other identifiers 1

IdentifierTypeStateIssuer
0155924MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mwitkoff1158478@direct.trinity-health.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040901001537 OH Practitioner - Emergency MedicinePractitioner - Family Practice 9133194087 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
5979OHMDClinical Psychologist
34-005979OHMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Signify Health, LLC CurrentSince Feb 5, 2024 Accepting new patients
Samaritan Emergency Corp Emergency Medicine Past Accepting new patients
Ohio Emergency Physicians LLC Emergency Medicine Past Accepting new patients
Great Lakes Emergency Medicine Physicians, Inc Emergency Medicine Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Immediate Health Associates Emergency Medicine Past Accepting new patients
Nes Ohio Inc Emergency Medicine Past Accepting new patients
Emergency Services, Inc. Emergency Medicine Past Accepting new patients

Locations

175 S 3rd St
Ste 200
Columbus, OH 43215
Phone (267) 817-8902

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

Organizations & group practices 8

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644969600000",
    "number": "1073591657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2376 VILLAGE AT BEXLEY DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432092896",
            "telephone_number": "614-402-3668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6001 E BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "43213",
            "telephone_number": "614-224-6420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITKOFF",
        "first_name": "MAURY",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-04",
        "last_updated": "2022-02-16",
        "certification_date": "2022-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "34-005979",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0155924",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mwitkoff1158478@direct.trinity-health.org",
            "affiliation": "N",
            "endpointDescription": "Mount Carmel Health Columbus Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "6001 E Broad St",
            "city": "Columbus",
            "state": "OH",
            "country_code": "US",
            "postal_code": "43213",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.