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Samaritan Family Care Inc

Organization Active NPI Family Medicine Physician · Dayton, OH

NPI 1265487342 · NPPES record last updated Nov 8, 2013

Key facts

NPI
1265487342
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
SAMARITAN FAMILY CARE INC
Practice address
9000 N Main St
Suite G-35
Dayton, OH 45415-1180
Phone
(937) 836-5170
Fax
(937) 836-1140
NPI assigned
May 24, 2006
Organization subpart
Yes
Parent organization (as reported)
SAMARITAN FAMILY CARE INC

Authorized official

Name
Kenneth Prunier
Title
Ceo/President
Phone
(937) 208-8213

Other NPIs on the same Medicare enrollment 19

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

  • Michael W Barrow, MD Family Medicine Physician · Dayton, OH · NPI 1700826005
    NPD FAMILY MEDICINE

Medicare participation

Medicare fee-for-service enrollment
Enrolled in OH

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040203000210 OH Part B Supplier - Clinic/Group Practice 5092608372 Receives reassigned benefits from 160 practitioners
19 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Englewood, OH; Vandalia, OH; New Lebanon, OH; Lewisburg, OH; Huber Heights, OH; Dayton, OH; Brookville, OH

National Provider Directory

Part of
Samaritan Pediatrics SF

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X Yes
Sports Medicine (Family Medicine) Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207QS0010X

Addresses

Primary practice location

9000 N Main St
Suite G-35
Dayton, OH 45415-1180

Mailing address

9000 N Main St
Suite G-35
Dayton, OH 45415-1180
Phone (937) 836-5170

Other identifiers

IdentifierTypeStateIssuer
0849569MedicaidOH

Other names

  • Samaritan North Family Physicians Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 8, 2013.

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383868800000",
    "number": "1265487342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 N MAIN ST",
            "address_2": "SUITE G-35",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454151180",
            "telephone_number": "937-836-5170",
            "fax_number": "937-836-1140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 N MAIN ST",
            "address_2": "SUITE G-35",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454151180",
            "telephone_number": "937-836-5170",
            "fax_number": "937-836-1140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMARITAN FAMILY CARE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAMARITAN FAMILY CARE INC",
        "enumeration_date": "2006-05-24",
        "last_updated": "2013-11-08",
        "status": "A",
        "authorized_official_last_name": "PRUNIER",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "937-208-8213"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0849569",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Samaritan North Family Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dayton, OH

All providers in Dayton, OH · Family Medicine Physician in Ohio

Sources for this page

Verify at the official NPI Registry.