Individual provider Active NPI

Bernadette Montante Deguzman, MD

  • Family Medicine Physician
  • Springfield, OH
National Provider Identifier
1194850594
Registry record updated Mar 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35090125 Issued in OH
Practice address
30 W McCreight Ave
Ste. 208
Springfield, OH 45504-1842
Phone
(937) 323-1187
Fax
(937) 323-1456
NPI assigned
Feb 23, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35090125 OH Primary

Addresses

Primary practice location

30 W McCreight Ave
Ste. 208
Springfield, OH 45504-1842

Mailing address

30 W McCreight Ave
Ste. 208
Springfield, OH 45504-1842
Phone (937) 323-1187

Other identifiers 1

IdentifierTypeStateIssuer
3034308MedicaidOH

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100510000405 OH Practitioner - Family Practice 5193853315 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wayne State University School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Health Physicians Springfield Primary Care LLCGroup PAC ID 7315361359, 37 clinicians

Practice addresses (Care Compare)

30 W McCreight Ave
Suite 208
Springfield, OH 45504-1853
Phone (937) 323-1187

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Physicians Springfield Primary Care LLC Family Medicine CurrentSince Sep 1, 2020 Accepting new patients

Locations

30 W McCreight Ave
Ste 208
Springfield, OH 45504
Phone (937) 323-1187

900 Scioto St
Ste 4
Urbana, OH 43078
Phone (937) 653-4666

Interoperability endpoints

  • Direct secure messaging: bdeguzman15958@direct.bsmhealth.org

Organizations & group practices 2

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458000000000",
    "number": "1194850594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 W MCCREIGHT AVE",
            "address_2": "STE. 208",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455041842",
            "telephone_number": "937-323-1187",
            "fax_number": "937-323-1456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 W MCCREIGHT AVE",
            "address_2": "STE. 208",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455041842",
            "telephone_number": "937-323-1187",
            "fax_number": "937-323-1456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEGUZMAN",
        "first_name": "BERNADETTE",
        "middle_name": "MONTANTE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-23",
        "last_updated": "2016-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35090125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3034308",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, OH

Sources for this page

Verify at the official NPI Registry.