Active NPI
Derek Engler
- Developmental Disabilities Clinic/Center
- Springfield, OH
National Provider Identifier
1104367218
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Disabilities Clinic/Center
- License
- 1204486
- Practice address
- 1012 Mavor St
Springfield, OH 45505-2848 - Phone
- (937) 360-7642
- NPI assigned
- Mar 9, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Disabilities Clinic/Center | 261QD1600X | 1204486 | OH | Primary |
Addresses
Primary practice location
1012 Mavor St
Springfield, OH 45505-2848
Mailing address
1012 Mavor St
Springfield, OH 45505-2848
Phone (937) 360-7642
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0208810 | Medicaid | OH | |
| 1204486 | Other | OH | DODD CONTRACT NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1204486 | OH | MD | Developmental Disabilities Clinic/Center |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1489017600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489017600000",
"number": "1104367218",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1012 MAVOR ST",
"city": "SPRINGFIELD",
"state": "OH",
"postal_code": "455052848",
"telephone_number": "937-360-7642"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1012 MAVOR ST",
"city": "SPRINGFIELD",
"state": "OH",
"postal_code": "455052848",
"telephone_number": "937-360-7642"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENGLER",
"first_name": "DEREK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-03-09",
"last_updated": "2017-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "261QD1600X",
"taxonomy_group": "",
"desc": "Clinic/Center, Developmental Disabilities",
"state": "OH",
"license": "1204486",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0208810",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DODD CONTRACT NUMBER",
"identifier": "1204486",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Springfield, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.