Active NPI
Samaritan Family Care Inc.
- Rheumatology Physician
- Dayton, OH
National Provider Identifier
1083669162
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rheumatology Physician
- Legal business name
- SAMARITAN FAMILY CARE INC.
- Practice address
- 9000 N Main St
Suite 200
Dayton, OH 45415-1180 - Phone
- (937) 890-6792
- Fax
- (937) 890-6828
- NPI assigned
- May 24, 2006
- Organization subpart
- Yes
- Parent organization
- SAMARITAN FAMILY CARE INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kenneth Prunier
- Title
- Ceo/President
- Phone
- (937) 208-8213
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rheumatology Physician | 207RR0500X | Primary |
Addresses
Primary practice location
9000 N Main St
Suite 200
Dayton, OH 45415-1180
Mailing address
9000 N Main St
Suite 200
Dayton, OH 45415-1180
Phone (937) 890-6792
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2603605 | Medicaid | OH | |
| 2814057 | Medicaid | OH |
Other names 1
- North Dayton Rheumatology
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040203000210 | OH | Part B Supplier - Clinic/Group Practice | 5092608372 |
Receives reassigned benefits from 160 practitioners 19 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Englewood, OH; Vandalia, OH; New Lebanon, OH; Lewisburg, OH; Huber Heights, OH; Dayton, OH; Brookville, OH |
Other NPIs on the same Medicare enrollment 19
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Family Medicine Physician
- Huber Heights, OH
- NPI 1467407544
O20040203000210
National Provider Directory
National Provider Directory- Part of
- Samaritan Pediatrics SF
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148428800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1383868800000",
"number": "1083669162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9000 N MAIN ST",
"address_2": "SUITE 200",
"city": "DAYTON",
"state": "OH",
"postal_code": "454151180",
"telephone_number": "937-890-6792",
"fax_number": "937-890-6828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9000 N MAIN ST",
"address_2": "SUITE 200",
"city": "DAYTON",
"state": "OH",
"postal_code": "454151180",
"telephone_number": "937-890-6792",
"fax_number": "937-890-6828"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SAMARITAN FAMILY CARE INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "SAMARITAN FAMILY CARE INC",
"enumeration_date": "2006-05-24",
"last_updated": "2013-11-08",
"status": "A",
"authorized_official_last_name": "PRUNIER",
"authorized_official_first_name": "KENNETH",
"authorized_official_title_or_position": "CEO/PRESIDENT",
"authorized_official_telephone_number": "937-208-8213"
},
"taxonomies": [
{
"code": "207RR0500X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine, Rheumatology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2603605",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2814057",
"state": "OH"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "North Dayton Rheumatology",
"code": "3",
"type": "Doing Business As"
}
]
}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 Nov 8, 2013; 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.