Organization Active NPI

Mvhe Inc

Doing business as Walden Ponds Primary Care

  • Internal Medicine Physician
  • Hamilton, OH
National Provider Identifier
1174631725
Registry record updated Nov 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MVHE INC
Doing business as
Walden Ponds Primary Care
Practice address
5971 Golf Club LN
Hamilton, OH 45011-8200
Phone
(513) 785-4339
Fax
(513) 785-4338
NPI assigned
Aug 25, 2006
Last updated
Nov 6, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
MVHE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 6, 2013

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

Authorized official

Name
Kenneth J Prunier
Title
President/Ceo
Phone
(937) 208-8213

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary
Pediatrics Physician 208000000X NU

Addresses

Primary practice location

5971 Golf Club LN
Hamilton, OH 45011-8200

Mailing address

5971 Golf Club LN
Hamilton, OH 45011-8200
Phone (513) 785-4339

Other identifiers 1

IdentifierTypeStateIssuer
2813389MedicaidOH

Other names 1

  • Walden Ponds Primary Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031217000553 OH Part B Supplier - Clinic/Group Practice 9537066584 Receives reassigned benefits from 777 practitioners
47 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Franklin, OH; Huber Heights, OH; Jamestown, OH; Kettering, OH; Lebanon, OH; Liberty Township, OH; Middletown, OH; Monroe, OH…

Other NPIs on the same Medicare enrollment 47

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

View all 47

National Provider Directory

National Provider Directory
Part of
Comprehensive Primary C

Locations

5971 Golf Club Ln
Fairfield Township, OH 45011
Phone (513) 785-4304

Practitioners & affiliated clinicians

Practitioners 1

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": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383696000000",
    "number": "1174631725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5971 GOLF CLUB LN",
            "city": "HAMILTON",
            "state": "OH",
            "postal_code": "450118200",
            "telephone_number": "513-785-4339",
            "fax_number": "513-785-4338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5971 GOLF CLUB LN",
            "city": "HAMILTON",
            "state": "OH",
            "postal_code": "450118200",
            "telephone_number": "513-785-4339",
            "fax_number": "513-785-4338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MVHE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MVHE INC",
        "enumeration_date": "2006-08-25",
        "last_updated": "2013-11-06",
        "status": "A",
        "authorized_official_last_name": "PRUNIER",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "937-208-8213"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2813389",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walden Ponds Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hamilton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2013; 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.