Premier Pediatric Group Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

PREMIER PEDIATRIC GROUP INC.

Practice address

5386 Cox Smith Road
Suite a
Mason, OH 45040

Phone

(513) 770-3466

Fax

(513) 770-3467

NPI assigned

May 17, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Bradley Jackson, M.D.

Title

Owner

Phone

(513) 770-3466

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093922072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 635228",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452630043",
            "telephone_number": "513-770-3466",
            "fax_number": "513-770-3467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5386 COX SMITH ROAD",
            "address_2": "SUITE A",
            "city": "MASON",
            "state": "OH",
            "postal_code": "45040",
            "telephone_number": "513-770-3466",
            "fax_number": "513-770-3467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PEDIATRIC GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "513-770-3466",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2426771",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA FOR ELIGABILITY",
            "identifier": "7200478",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Providers in Mason, OH by specialty
• Specialist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.