Internal Medicine Associates of Clinton County Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

INTERNAL MEDICINE ASSOCIATES OF CLINTON COUNTY INC

Practice address

891 W Locust St
Wilmington, OH 45177-2118

Phone

(937) 382-5030

Fax

(937) 655-8390

NPI assigned

Aug 24, 2005

Organization subpart

No

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

Authorized official

Name

Dr. Bruce Edmund Staley, MD

Title

President

Phone

(937) 382-5030

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

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

• Katherine Moore, FNP-C

  • Family Nurse Practitioner
  • Wilmington, OH
  • NPI 1740834316
  NPD (past)

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

{
    "created_epoch": "1124841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1134112329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "891 W LOCUST ST",
            "city": "WILMINGTON",
            "state": "OH",
            "postal_code": "451772118",
            "telephone_number": "937-382-5030",
            "fax_number": "937-655-8390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "891 W LOCUST ST",
            "city": "WILMINGTON",
            "state": "OH",
            "postal_code": "451772118",
            "telephone_number": "937-382-5030",
            "fax_number": "937-655-8390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE ASSOCIATES OF CLINTON COUNTY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-24",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "STALEY",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "EDMUND",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "937-382-5030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0385373",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "IN9287061",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jason Pittser OD Inc.

• Internal Medicine Physician in Wilmington, OH
• Providers in Wilmington, OH by specialty
• Internal Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.