Shiloh Family Medicine LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SHILOH FAMILY MEDICINE LLC

Practice address

5900 N Main St Ste 3
Dayton, OH 45415-3198

Phone

(937) 277-9371

NPI assigned

Sep 11, 2007

Last updated

Jan 3, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Edward Clack, MDNPI 1659629053

Title

Physician

Phone

(937) 277-9371

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 3

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.

• Edward Petersen Clack, DO

  • Family Medicine Physician
  • Dayton, OH
  • NPI 1659629053
  Medicare reassignment Care Compare group NPD Authorized official
• Zachary James Hale, APRN, NP-C

  • Primary Care Nurse Practitioner
  • Beavercreek, OH
  • NPI 1356992028
  Medicare reassignment Care Compare group NPD
• Eric Harris, FNP

  • Family Nurse Practitioner
  • Centerville, OH
  • NPI 1033409628
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1189468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672704000000",
    "number": "1255526471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5900 N MAIN ST STE 3",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454153198",
            "telephone_number": "937-277-9371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 N MAIN ST STE 3",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454153198",
            "telephone_number": "937-277-9371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHILOH FAMILY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-11",
        "last_updated": "2023-01-03",
        "certification_date": "2023-01-03",
        "status": "A",
        "authorized_official_last_name": "CLACK",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "937-277-9371",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2353911",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000236927",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Shevchik
• Jenna Leigh Shevlin, D.D.S
• David William Shie, M.D.
• John Mark Shie, M.D.
• Staci Elaine Shields, CNS
• Shiloh Optometric Center Inc
• Megan Elizabeth Shilt
• Joon Shim, M.D.
• Charles T Shine, CRNA
• Najee Shine

• Family Medicine Physician in Dayton, OH
• Providers in Dayton, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2023; 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.