Individual provider Active NPI

Timothy A. Maclean, D.O.

  • Emergency Medicine Physician
  • Dayton, OH
National Provider Identifier
1093806473
Registry record updated Mar 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
34-005293 Issued in OH
Practice address
1 Wyoming St
Dayton, OH 45409-2722
Phone
(513) 281-4400
Fax
(513) 587-8213
NPI assigned
Sep 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2014

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 34-005293 OH Primary

Addresses

Primary practice location

1 Wyoming St
Dayton, OH 45409-2722

Mailing address

2950 Robertson Ave
Cincinnati, OH 45209-1268
Phone (513) 281-4400

Other identifiers 1

IdentifierTypeStateIssuer
0839392MedicaidOH

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
I20100921000009 OH Practitioner - Emergency Medicine 9133024714 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34-005293OHMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Miami Valley Emergency Specialists, LLC Emergency Medicine CurrentSince Jun 12, 2000 Accepting new patients
Lifecare Hospice Past Accepting new patients

Locations

1 Wyoming St
Dayton, OH 45409
Phone (937) 208-2636

Organizations & group practices 4

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": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395100800000",
    "number": "1093806473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2950 ROBERTSON AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452091268",
            "telephone_number": "513-281-4400",
            "fax_number": "513-587-8213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WYOMING ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454092722",
            "telephone_number": "513-281-4400",
            "fax_number": "513-587-8213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACLEAN",
        "first_name": "TIMOTHY",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2014-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "34-005293",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0839392",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.