Active NPI
Health Specialists of Dayton Inc
- Obstetrics & Gynecology Physician
- Springboro, OH
National Provider Identifier
1275586984
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- Legal business name
- HEALTH SPECIALISTS OF DAYTON INC
- Doing business as
- Beavercreek OB/Gyn
- Practice address
- 630 N Main St
Ste 200a
Springboro, OH 45066-7519 - Phone
- (937) 748-8516
- Fax
- (937) 748-8593
- NPI assigned
- May 17, 2006
- Organization subpart
- Yes
- Parent organization
- HEALTH SPECIALISTS OF DAYTON INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kenneth Prunier
- Title
- Ceo and President
- Phone
- (937) 208-8252
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | Primary |
Addresses
Primary practice location
630 N Main St
Ste 200a
Springboro, OH 45066-7519
Mailing address
630 N Main St
Ste 200a
Springboro, OH 45066-7519
Phone (937) 748-8516
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2813334 | Medicaid | OH |
Other names 1
- Beavercreek OB/Gyn
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050610000010 | OH | Part B Supplier - Clinic/Group Practice | 5597708594 |
Receives reassigned benefits from 938 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider Directory- Part of
- Premier Health Specialist Inc
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147824000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1320364800000",
"number": "1275586984",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 N MAIN ST",
"address_2": "STE 200A",
"city": "SPRINGBORO",
"state": "OH",
"postal_code": "450667519",
"telephone_number": "937-748-8516",
"fax_number": "937-748-8593"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 N MAIN ST",
"address_2": "STE 200A",
"city": "SPRINGBORO",
"state": "OH",
"postal_code": "450667519",
"telephone_number": "937-748-8516",
"fax_number": "937-748-8593"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HEALTH SPECIALISTS OF DAYTON INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "HEALTH SPECIALISTS OF DAYTON INC",
"enumeration_date": "2006-05-17",
"last_updated": "2011-11-04",
"status": "A",
"authorized_official_last_name": "PRUNIER",
"authorized_official_first_name": "KENNETH",
"authorized_official_title_or_position": "CEO AND PRESIDENT",
"authorized_official_telephone_number": "937-208-8252"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Obstetrics & Gynecology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2813334",
"state": "OH"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Beavercreek OB/Gyn",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Springboro, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2011; 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.