Organization Active NPI

Westerville Pediatric Specialists, Inc.

  • Pediatrics Physician
  • Westerville, OH
National Provider Identifier
1104989334
Registry record updated Jul 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
WESTERVILLE PEDIATRIC SPECIALISTS, INC.
Practice address
575 Westar Crossing
Suite 101
Westerville, OH 43082-7800
Phone
(614) 508-2223
Fax
(614) 508-2233
NPI assigned
Dec 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2016

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

Authorized official

Name
Kathleen M Wodarcyk, M.D.
Title
President
Phone
(614) 508-2223

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208000000X
Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208000000X OH Primary

Addresses

Primary practice location

575 Westar Crossing
Suite 101
Westerville, OH 43082-7800

Mailing address

575 Westar Crossing
Suite 101
Westerville, OH 43082-7800
Phone (614) 508-2223

Other identifiers 1

IdentifierTypeStateIssuer
2288546MedicaidOH

Other names 1

  • Sunbury Mills Pediatrics Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D0327896Westerville Pediatric Specialists, Inc575 Westar Crossing, Ste 101, Westerville, OH 43082Certificate of waiverDec 22, 2027

National Provider Directory

National Provider Directory

Locations

700 W Cherry St
Ste A
Sunbury, OH 43074
Phone (740) 965-5500

700 W Cherry St
Ste B
Sunbury, OH 43074
Phone (740) 625-5326

575 Westar Xing
Ste 101
Westerville, OH 43082
Phone (614) 508-2223

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467936000000",
    "number": "1104989334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 WESTAR CROSSING",
            "address_2": "SUITE 101",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430827800",
            "telephone_number": "614-508-2223",
            "fax_number": "614-508-2233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 WESTAR CROSSING",
            "address_2": "SUITE 101",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430827800",
            "telephone_number": "614-508-2223",
            "fax_number": "614-508-2233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERVILLE PEDIATRIC SPECIALISTS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2016-07-08",
        "status": "A",
        "authorized_official_last_name": "WODARCYK",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "614-508-2223",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2288546",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sunbury Mills Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Westerville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.