NPIMap

Organization Active NPI

Allergy and Asthma Center, Inc

  • Allergy & Immunology Physician
  • Wilmington, OH
National Provider Identifier
1104913417
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
License
35080833 Issued in OH
Legal business name
ALLERGY AND ASTHMA CENTER, INC
Practice address
110 Fairway Dr
Suite # 2
Wilmington, OH 45177-8756
Phone
(937) 655-9179
Fax
(937) 655-9139
NPI assigned
Oct 6, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Vidyashankar B Revan, M.D.NPI 1194882571
Title
MD / President
Phone
(937) 655-9179

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology Physician 207K00000X 35080833 OH Primary

Addresses

Primary practice location

110 Fairway Dr
Suite # 2
Wilmington, OH 45177-8756

Mailing address

110 Fairway Dr
Suite # 2
Wilmington, OH 45177-8756
Phone (937) 655-9179

Other identifiers 5

IdentifierTypeStateIssuer
D80833OtherHUMANA / CHOICE CARE ID
2321660MedicaidOH
DD 2704OtherRAILROAD MEDICARE ID #
0200482OtherUNITED HEALTH CARE
000000237118OtherBLUECROSS AND BLUESHIELD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 35

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104913417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 FAIRWAY DR",
            "address_2": "SUITE # 2",
            "city": "WILMINGTON",
            "state": "OH",
            "postal_code": "451778756",
            "telephone_number": "937-655-9179",
            "fax_number": "937-655-9139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 FAIRWAY DR",
            "address_2": "SUITE # 2",
            "city": "WILMINGTON",
            "state": "OH",
            "postal_code": "451778756",
            "telephone_number": "937-655-9179",
            "fax_number": "937-655-9139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLERGY AND ASTHMA CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "REVAN",
        "authorized_official_first_name": "VIDYASHANKAR",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "MD / PRESIDENT",
        "authorized_official_telephone_number": "937-655-9179",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "OH",
            "license": "35080833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA / CHOICE CARE ID",
            "identifier": "D80833",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2321660",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE ID #",
            "identifier": "DD 2704",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "0200482",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS AND BLUESHIELD",
            "identifier": "000000237118",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, OH

Sources for this page

  • 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.