NPIMap

Individual provider Active NPI

Mae Tahireh Gallagher, M.D.

  • Family Medicine Physician
  • Granville, OH
National Provider Identifier
1073907507
Registry record updated Jun 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35.129901 Issued in OH
Practice address
2000 Newark Granville Rd Ste 100
Granville, OH 43023
Phone
(740) 587-0087
Fax
(740) 587-0084
NPI assigned
Mar 23, 2015
Last updated
Jun 8, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Family Medicine Physician 207Q00000X 35.129901 OH Primary

Addresses

Primary practice location

2000 Newark Granville Rd Ste 100
Granville, OH 43023

Mailing address

2000 Newark Granville Rd Ste 100
Granville, OH 43023-7009
Phone (407) 587-0087

Other practice location 1

697 Thomas Ln
Columbus, OH 43214-3931
Phone (614) 566-5414

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180706002274 OH Practitioner - Family Practice 6800104282 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Toledo College of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4885 Olentangy River Rd
Columbus, OH 43214-1952
Phone (614) 326-5665

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Central Ohio Primary Care Physicians Inc Current Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mgallagher18798@copcp.medicity.net

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1427068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528416000000",
    "number": "1073907507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 NEWARK GRANVILLE RD STE 100",
            "city": "GRANVILLE",
            "state": "OH",
            "postal_code": "430237009",
            "telephone_number": "407-587-0087",
            "fax_number": "740-587-0084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 NEWARK GRANVILLE RD STE 100",
            "city": "GRANVILLE",
            "state": "OH",
            "postal_code": "43023",
            "telephone_number": "740-587-0087",
            "fax_number": "740-587-0084"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "697 Thomas Ln",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432143931",
            "country_code": "US",
            "telephone_number": "614-566-5414",
            "fax_number": "614-533-0433",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GALLAGHER",
        "first_name": "MAE",
        "middle_name": "TAHIREH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-23",
        "last_updated": "2018-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.129901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Granville, OH

Sources for this page

Verify at the official NPI Registry.