Individual provider Active NPI

Edward J Severyn, MD

  • Internal Medicine Physician
  • Chillicothe, OH
National Provider Identifier
1205944741
Registry record updated May 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35048838 Issued in OH
Practice address
17273 State Route 104
Chillicothe, OH 45601-9718
Phone
(513) 405-3845
NPI assigned
Aug 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35048838 OH Primary

Addresses

Primary practice location

17273 State Route 104
Chillicothe, OH 45601-9718

Mailing address

17273 State Route 104
Chillicothe, OH 45601-9718
Phone (513) 405-3845

Other identifiers 1

IdentifierTypeStateIssuer
0514554MedicaidOH

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
I20130521000646 OH Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 7214831858

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35048838OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
E Cincinnati Inter Med Internal Medicine Past Accepting new patients

Organizations & group practices 1

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": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368316800000",
    "number": "1205944741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17273 STATE ROUTE 104",
            "city": "CHILLICOTHE",
            "state": "OH",
            "postal_code": "456019718",
            "telephone_number": "513-405-3845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17273 STATE ROUTE 104",
            "city": "CHILLICOTHE",
            "state": "OH",
            "postal_code": "456019718",
            "telephone_number": "513-405-3845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEVERYN",
        "first_name": "EDWARD",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2013-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35048838",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0514554",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chillicothe, OH

Sources for this page

Verify at the official NPI Registry.