NPIMap

Organization Active NPI

Southwest Ohio Developmental Center

  • Intellectual Disabilities Intermediate Care Facility
  • Batavia, OH
National Provider Identifier
1124180658
Registry record updated Aug 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
1310875 Issued in OH
Legal business name
SOUTHWEST OHIO DEVELOPMENTAL CENTER
Practice address
4399 E Bauman LN
Batavia, OH 45103-1685
Phone
(513) 732-9200
Fax
(513) 735-8232
NPI assigned
Dec 14, 2006
Last updated
Aug 30, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2010

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

Authorized official

Name
Mr. James C. Krumer, MBA
Title
Superintendent
Phone
(513) 732-9200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 1310875 OH Primary

Addresses

Primary practice location

4399 E Bauman LN
Batavia, OH 45103-1685

Mailing address

4399 E Bauman LN
Batavia, OH 45103-1685
Phone (513) 732-9200

Other names 1

  • SODC Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031202000209 OH Part B Supplier - Clinic/Group Practice 0143133181 Receives reassigned benefits from 261 practitioners
28 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Northfield, OH; Youngstown, OH; Toledo, OH; Tiffin, OH; Mt Vernon, OH; Mineral Ridge, OH; Massillon, OH; Huber Heights, OH…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124180658. Details of each certification follow.

  • CCN 36G595 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 36G595

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SOUTHWEST OHIO DEVELOPMENTAL CENTER
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Sep 15, 2003
Last certification
Aug 21, 2025
Beds
112
Ownership / control type
State
Facility address
4399 East Bauman Lane
Batavia, OH 45103

Other NPIs on the same Medicare enrollment 26

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 26

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
36D0956037Southwest Ohio Developmental Center4399 East Bauman Lane, Batavia, OH 45103Certificate of waiverJan 18, 2027

National Provider Directory

National Provider Directory
Tax ID family
Tiffin Developmental Center39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

Organizations that report the same tax identification number in the National Provider Directory.

View all 38

Locations

4399 E Bauman Ln
Batavia, OH 45103
Phone (513) 732-9200

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283126400000",
    "number": "1124180658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4399 E BAUMAN LN",
            "city": "BATAVIA",
            "state": "OH",
            "postal_code": "451031685",
            "telephone_number": "513-732-9200",
            "fax_number": "513-735-8232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4399 E BAUMAN LN",
            "city": "BATAVIA",
            "state": "OH",
            "postal_code": "451031685",
            "telephone_number": "513-732-9200",
            "fax_number": "513-735-8232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST OHIO DEVELOPMENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2010-08-30",
        "status": "A",
        "authorized_official_last_name": "KRUMER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "SUPERINTENDENT",
        "authorized_official_telephone_number": "513-732-9200",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "OH",
            "license": "1310875",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SODC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Batavia, OH

Sources for this page

Verify at the official NPI Registry.