NPIMap

Individual provider Active NPI

Ronald E Wollum III, PAC

  • Physician Assistant
  • Springfield, OH
National Provider Identifier
1215983879
Registry record updated Aug 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50002301 Issued in OH
Practice address
1416 W 1St St
Springfield, OH 45504
Phone
(937) 322-1700
Fax
(937) 322-8070
NPI assigned
May 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9106675 FL
Physician Assistant 363A00000X 50002301 OH Primary

Addresses

Primary practice location

1416 W 1St St
Springfield, OH 45504

Mailing address

3070 Presidential Dr
Suite 200
Fairborn, OH 45324-6293
Phone (937) 429-2160

Other practice location 1

2020 59th St W
Bradenton, FL 34209-4604
Phone (706) 863-9595

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151202002183 OH Practitioner - Physician Assistant 6608804026 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
50002301OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Spfld Urb Emergency Physicians Inc Past Accepting new patients
Northport Emergency Associates, PA Past Accepting new patients
Ohio Institute of Cardiac Care, Inc Past Accepting new patients
Sarasota Emergency Associates PA Past Accepting new patients
Ambulatory Care Physicians of Sarasota LLC Past Accepting new patients
Springfield Emergency Physicians, Inc. Past Accepting new patients
Spfld Urb Emergency Physicians Inc Past Accepting new patients

Organizations & group practices 8

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": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534982400000",
    "number": "1215983879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3070 PRESIDENTIAL DR",
            "address_2": "SUITE 200",
            "city": "FAIRBORN",
            "state": "OH",
            "postal_code": "453246293",
            "telephone_number": "937-429-2160",
            "fax_number": "937-426-5663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1416 W 1ST ST",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "45504",
            "telephone_number": "937-322-1700",
            "fax_number": "937-322-8070"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2020 59th St W",
            "address_purpose": "LOCATION",
            "city": "Bradenton",
            "state": "FL",
            "postal_code": "342094604",
            "country_code": "US",
            "telephone_number": "706-863-9595",
            "fax_number": "706-868-8375",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOLLUM",
        "first_name": "RONALD",
        "middle_name": "E",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2018-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9106675",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50002301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, OH

Sources for this page

Verify at the official NPI Registry.