Individual provider Active NPI

Mark Robert Duffy, DMD

  • General Practice Dentistry
  • Columbus, OH
National Provider Identifier
1194255513
Registry record updated Oct 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
30.025112 Issued in OH
Practice address
2300 W Broad St
Columbus, OH 43204-3783
Phone
(614) 645-2300
Fax
(614) 645-5517
NPI assigned
Jun 18, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 30.025112 OH Primary

Addresses

Primary practice location

2300 W Broad St
Columbus, OH 43204-3783

Mailing address

2780 Airport Dr Ste 100
Columbus, OH 43219-2289
Phone (614) 859-1906

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180320002943 OH Practitioner - Dentist 8426310970 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Columbus Neighborhood Health Center Inc Current Accepting new patients
Columbus Neighborhood Health Center Inc CurrentSince Dec 2, 2019 Accepting new patients
Columbus Neighborhood Health Center Inc Current Accepting new patients
Columbus Neighborhood Health Center Inc CurrentSince Dec 2, 2019 Accepting new patients

Locations

L3318
Columbus, OH 43260

2780 Airport Dr
Ste 100
Columbus, OH 43219
Phone (614) 859-1906

1180 E Main St
Columbus, OH 43205
Phone (614) 253-0861

2300 W Broad St
Columbus, OH 43204
Phone (614) 645-2300

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1497744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570060800000",
    "number": "1194255513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2780 AIRPORT DR STE 100",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432192289",
            "telephone_number": "614-859-1906",
            "fax_number": "614-645-5517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 W BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432043783",
            "telephone_number": "614-645-2300",
            "fax_number": "614-645-5517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUFFY",
        "first_name": "MARK",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-18",
        "last_updated": "2019-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30.025112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.