Organization Active NPI

Premier Health Specialists Inc

  • Internal Medicine Physician
  • Moraine, OH
National Provider Identifier
1194958223
Registry record updated Jul 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PREMIER HEALTH SPECIALISTS INC
Practice address
3170 Kettering Blvd
Building B 3Rd Floor
Moraine, OH 45439-1924
Phone
(937) 991-3188
Fax
(937) 223-9811
NPI assigned
Aug 24, 2009
Last updated
Jul 27, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2026

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

Authorized official

Name
Renee Mock
Title
VP & Cfo - PPN & Fidelity
Phone
(937) 208-6439

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU
Clinical Psychologist 103TC0700X NU
Transplant Surgery Physician 204F00000X NU
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU Primary
Cardiovascular Disease Physician 207RC0000X NU
Critical Care Medicine (Internal Medicine) Physician 207RC0200X NU
Interventional Cardiology Physician 207RI0011X NU
Infectious Disease Physician 207RI0200X NU
Nuclear Cardiology Physician 207UN0901X NU
Obstetrics & Gynecology Physician 207V00000X NU
Surgery Physician 208600000X NU
Urology Physician 208800000X NU
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X NU

Addresses

Primary practice location

3170 Kettering Blvd
Building B 3Rd Floor
Moraine, OH 45439-1924

Mailing address

3170 Kettering Blvd
Building B 3Rd Floor
Moraine, OH 45439-1924
Phone (937) 991-3188

Other practice location 1

2400 Lakeview Dr Ste 210
Beavercreek, OH 45431-2581
Phone (937) 312-1661

Other practice location 2

2400 Lakeview Dr Ste 220
Beavercreek, OH 45431-2581
Phone (937) 320-0630

Other practice location 3

2300 Miami Valley Dr Ste 380B
Centerville, OH 45459-1297
Phone (937) 832-9310

Other practice location 4

9000 N Main St Ste 233
Englewood, OH 45415-1184
Phone (937) 832-9310

Other practice location 5

600 Aviator Ct
Ste 220
Vandalia, OH 45377
Phone (937) 335-3518

Other practice location 6

600 Aviator Ct
Ste 210
Vandalia, OH 45377
Phone (937) 335-3561

Other practice location 7

2300 Miami Valley Dr Ste 260
Centerville, OH 45459-1294
Phone (937) 438-7800

Other identifiers 1

IdentifierTypeStateIssuer
0081671MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050610000010 OH Part B Supplier - Clinic/Group Practice 5597708594 Receives reassigned benefits from 938 practitioners

National Provider Directory

National Provider Directory

Locations

2400 Lakeview Dr
Ste 210
Beavercreek, OH 45431
Phone (937) 312-1661

2400 Lakeview Dr
Ste 220
Beavercreek, OH 45431
Phone (937) 320-0630

2400 Lakeview Dr
Ste 260B
Beavercreek, OH 45431
Phone (937) 208-3463

2300 Miami Valley Dr
Fl 4
Centerville, OH 45459
Phone (937) 276-8320

2300 Miami Valley Dr
Ste 380B
Centerville, OH 45459
Phone (937) 832-9310

2350 Miami Valley Dr
Ste 410
Centerville, OH 45459
Phone (937) 281-2370

2400 Miami Valley Dr
#1000
Centerville, OH 45459

1 Wyoming St
#F1
Dayton, OH 45409
Phone (937) 208-2516

1 Wyoming St
Ste 3115A
Dayton, OH 45409
Phone (937) 734-4363

1 Wyoming St
Ste 4140A
Dayton, OH 45409
Phone (937) 208-4110

2350 Miami Valley Dr
Ste 310
Dayton, OH 45459
Phone (937) 435-4263

2350 Miami Valley Dr
Ste 320A
Dayton, OH 45459
Phone (937) 312-1661

30 E Apple St
#L200
Dayton, OH 45409
Phone (937) 208-2020

6251 Miami Valley Way
Ste 120B
Huber Heights, OH 45424
Phone (937) 832-4773

6615 Cincinnati Dayton Rd
Ste B
Liberty Township, OH 45044
Phone (937) 832-9310

400 Sugar Camp Cir
Ste 200
Oakwood, OH 45409
Phone (937) 262-7819

3130 N County Road 25A
Ste 114
Troy, OH 45373
Phone (937) 440-7665

600 Aviator Ct
Ste 220
Vandalia, OH 45377
Phone (937) 335-3518

Practitioners & affiliated clinicians

Practitioners 954

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.

View all 954

NPI Registry JSON

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

{
    "created_epoch": "1251072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785110400000",
    "number": "1194958223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3170 KETTERING BLVD",
            "address_2": "BUILDING B 3RD FLOOR",
            "city": "MORAINE",
            "state": "OH",
            "postal_code": "454391924",
            "telephone_number": "937-991-3188",
            "fax_number": "937-223-9811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3170 KETTERING BLVD",
            "address_2": "BUILDING B 3RD FLOOR",
            "city": "MORAINE",
            "state": "OH",
            "postal_code": "454391924",
            "telephone_number": "937-991-3188",
            "fax_number": "937-223-9811"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2400 Lakeview Dr Ste 210",
            "address_purpose": "LOCATION",
            "city": "Beavercreek",
            "state": "OH",
            "postal_code": "454312581",
            "country_code": "US",
            "telephone_number": "937-312-1661",
            "fax_number": "937-312-1701",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2400 Lakeview Dr Ste 220",
            "address_purpose": "LOCATION",
            "city": "Beavercreek",
            "state": "OH",
            "postal_code": "454312581",
            "country_code": "US",
            "telephone_number": "937-320-0630",
            "fax_number": "937-320-0633",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2300 Miami Valley Dr Ste 380B",
            "address_purpose": "LOCATION",
            "city": "Centerville",
            "state": "OH",
            "postal_code": "454591297",
            "country_code": "US",
            "telephone_number": "937-832-9310",
            "fax_number": "937-832-8613",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9000 N Main St Ste 233",
            "address_purpose": "LOCATION",
            "city": "Englewood",
            "state": "OH",
            "postal_code": "454151184",
            "country_code": "US",
            "telephone_number": "937-832-9310",
            "fax_number": "937-832-8613",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "600 Aviator Ct",
            "address_2": "Ste 220",
            "address_purpose": "LOCATION",
            "city": "Vandalia",
            "state": "OH",
            "postal_code": "45377",
            "country_code": "US",
            "telephone_number": "937-335-3518",
            "fax_number": "937-332-6857",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "600 Aviator Ct",
            "address_2": "Ste 210",
            "address_purpose": "LOCATION",
            "city": "Vandalia",
            "state": "OH",
            "postal_code": "45377",
            "country_code": "US",
            "telephone_number": "937-335-3561",
            "fax_number": "937-339-1213",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2300 Miami Valley Dr Ste 260",
            "address_purpose": "LOCATION",
            "city": "Centerville",
            "state": "OH",
            "postal_code": "454591294",
            "country_code": "US",
            "telephone_number": "937-438-7800",
            "fax_number": "937-438-7811",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PREMIER HEALTH SPECIALISTS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-24",
        "last_updated": "2026-07-27",
        "certification_date": "2026-07-27",
        "status": "A",
        "authorized_official_last_name": "MOCK",
        "authorized_official_first_name": "RENEE",
        "authorized_official_title_or_position": "VP & CFO - PPN & FIDELITY",
        "authorized_official_telephone_number": "937-208-6439"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "204F00000X",
            "taxonomy_group": "",
            "desc": "Transplant Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0081671",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moraine, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2026; 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.