Southwest Ohio Developmental Center
Organization Active NPI Intellectual Disabilities Intermediate Care Facility · Batavia, OH
NPI 1124180658 · NPPES record last updated Aug 30, 2010
Key facts
- NPI
- 1124180658
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Intellectual Disabilities Intermediate Care Facility 315P00000X
- License
- 1310875 (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
- Organization subpart
- No
Authorized official
- Name
- Mr. James C. Krumer, MBA
- Title
- Superintendent
- Phone
- (513) 732-9200
Other NPIs on the same Medicare enrollment 26
Corporate family (same tax ID) 40
Practitioners 2
-
Larry A. Graham, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 36D0956037 | Southwest Ohio Developmental Center | Certificate of waiver | Jan 18, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
National Provider Directory
- Tax ID family
- Central Ohio Pyschiatri
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual Disabilities Intermediate Care Facility | 315P00000X | 1310875 | OH | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1310875 | Other | OH | MRDD LICENSE OHIO |
| 2423694 | Medicaid | OH |
Other names
- SODC
Other providers in Batavia, OH
- James Brian Smith
- Courtney Snider
- Mindy Snider
- Whitney Rachelle Snider
- Regina Faye Snow
- Michelle Lynn Spoon
- Deborah Spradlin
- Erin Stacy-Hamilton
- Ashley Stacy
- Erika Staderman
All providers in Batavia, OH · Intellectual Disabilities Intermediate Care Facility in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 30, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.