Organization Active NPI

J. Terebuh MD Inc

  • Optometrist
  • Bellefontaine, OH
National Provider Identifier
1194744102
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
J. TEREBUH MD INC
Practice address
1107 Rush Ave
Bellefontaine, OH 43311-9488
Phone
(937) 593-3881
Fax
(937) 593-3881
NPI assigned
Jul 19, 2006
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Kristy Young
Title
MGR
Phone
(937) 593-3881

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X Primary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X

Addresses

Primary practice location

1107 Rush Ave
Bellefontaine, OH 43311-9488

Mailing address

PO Box 190
1107 Rush Ave
Bellefontaine, OH 43311-0190
Phone (937) 593-3881

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100301000069 OH Part B Supplier - Clinic/Group Practice 0749183416 Receives reassigned benefits from 4 practitioners
Practice locations: Bellefontaine, OH
O20100930013743 OH DME Supplier - Physician - OptometristDME Supplier - Optician 0749183416 Practice locations: Bellefontaine, OH

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
J. Terebuh MD Inc1107 Rush Ave, Bellefontaine, OH 43311-9488(937) 593-5735 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Aug 19, 1999

National Provider Directory

National Provider Directory

Locations

1107 Rush Ave
Ste 100
Bellefontaine, OH 43311

1107 Rush Ave
Unit 190
Bellefontaine, OH 43311

Practitioners & affiliated clinicians

Practitioners 7

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": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1194744102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190",
            "address_2": "1107 RUSH AVE",
            "city": "BELLEFONTAINE",
            "state": "OH",
            "postal_code": "433110190",
            "telephone_number": "937-593-3881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 RUSH AVE",
            "city": "BELLEFONTAINE",
            "state": "OH",
            "postal_code": "433119488",
            "telephone_number": "937-593-3881",
            "fax_number": "937-593-3881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J. TEREBUH MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "KRISTY",
        "authorized_official_title_or_position": "MGR",
        "authorized_official_telephone_number": "937-593-3881"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellefontaine, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.