NPIMap

Organization Active NPI

Ohio State Dental Faculty Practice Inc

  • Dentist
  • Columbus, OH
National Provider Identifier
1164537684
Registry record updated Nov 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
OHIO STATE DENTAL FACULTY PRACTICE INC
Practice address
305 W. 12TH Avenue
4TH Floor Postle Hall
Columbus, OH 43210-1267
Phone
(614) 292-1472
Fax
(614) 688-3553
NPI assigned
Aug 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2021

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

Authorized official

Name
Mrs. Linda Murray Myers, MHHA
Title
Director
Phone
(614) 688-4378

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

305 W. 12TH Avenue
4TH Floor Postle Hall
Columbus, OH 43210-1267

Mailing address

305 W 12TH Ave
2301 Postle Hall
Columbus, OH 43210-1267
Phone (614) 292-1472

Other identifiers 1

IdentifierTypeStateIssuer
0799104MedicaidOH

Other names 3

  • Ohio State Dental Faculty Practice Inc- John R Kalmar, DMD, PhD Other name
  • Ohio State Dental Faculty Practice Inc. - John R Kalmar, DMD, PHD Other name
  • Ohio State Dental Faculty Practice Inc. -John R. Kalmar, DMD, PHD Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050916000944 OH Part B Supplier - Clinic/Group Practice 5496788630 Receives reassigned benefits from 11 practitioners
Practice locations: Columbus, OH

National Provider Directory

National Provider Directory

Locations

305 W 12th Ave
#2301
Columbus, OH 43210

305 W 12th Ave
Fl 4
Columbus, OH 43210
Phone (614) 292-3596

305 W 12th Ave
Rm 2301
Columbus, OH 43210
Phone (614) 292-1472

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636416000000",
    "number": "1164537684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 W 12TH AVE",
            "address_2": "2301 POSTLE HALL",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432101267",
            "telephone_number": "614-292-1472",
            "fax_number": "614-688-3553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 W. 12TH AVENUE",
            "address_2": "4TH FLOOR POSTLE HALL",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432101267",
            "telephone_number": "614-292-1472",
            "fax_number": "614-688-3553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OHIO STATE DENTAL FACULTY PRACTICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-21",
        "last_updated": "2021-11-09",
        "certification_date": "2021-11-09",
        "status": "A",
        "authorized_official_last_name": "MYERS",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "MURRAY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "614-688-4378",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MHHA"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0799104",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ohio State Dental Faculty Practice Inc- John R Kalmar, DMD, PhD",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Ohio State Dental Faculty Practice Inc. - John R Kalmar, DMD, PHD",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Ohio State Dental Faculty Practice Inc. -John R. Kalmar, DMD, PHD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Columbus, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.