Timothy Maxwell Pelfrey, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

35 . 047727 Issued in OH

Practice address

498 London Ave
Suite B
Marysville, OH 43040-5512

Phone

(937) 642-0046

Fax

(937) 642-2012

NPI assigned

Aug 1, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194732529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13827 FAIRWAY DR",
            "city": "MARYSVILLE",
            "state": "OH",
            "postal_code": "430409019",
            "telephone_number": "937-644-0102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "498 LONDON AVE",
            "address_2": "SUITE B",
            "city": "MARYSVILLE",
            "state": "OH",
            "postal_code": "430405512",
            "telephone_number": "937-642-0046",
            "fax_number": "937-642-2012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELFREY",
        "first_name": "TIMOTHY",
        "middle_name": "MAXWELL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "35 . 047727",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0594763",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Surgery Physician in Marysville, OH
• Providers in Marysville, OH by specialty
• Surgery Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.