NPIMap

Organization Active NPI

Premier Integrated Medical Assoc LTD

  • Family Medicine Physician
  • Kettering, OH
National Provider Identifier
1285690339
Registry record updated Dec 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PREMIER INTEGRATED MEDICAL ASSOC LTD
Practice address
1900 Composite Dr
Kettering, OH 45420-1475
Phone
(937) 293-8419
Fax
(937) 293-1545
NPI assigned
Apr 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2022

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

Authorized official

Name
Dr. Mark A Couch, MD
Title
President
Phone
(937) 898-3600

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X

Addresses

Primary practice location

1900 Composite Dr
Kettering, OH 45420-1475

Mailing address

1900 Composite Dr
Kettering, OH 45420-1475
Phone (937) 293-8419

Other practice location 1

3080 Ackerman Blvd Ste 215
Dayton, OH 45429-3658
Phone (937) 534-4201

Other practice location 2

3080 Ackerman Blvd Ste 210
Dayton, OH 45429-3658
Phone (937) 534-4201

Other practice location 3

948 Patterson Rd
Dayton, OH 45419-4336
Phone (937) 320-3888

Other practice location 4

200 Rockridge Rd Ste 100
Englewood, OH 45322-2748
Phone (937) 274-2117

Other practice location 5

3333 W Tech Blvd Ste 120
Miamisburg, OH 45342-0956
Phone (937) 748-6116

Other practice location 6

6551 Centerville Business Parkway
Family Practice Ste 100
Dayton, OH 45459-2686
Phone (937) 291-6830

Other practice location 7

200 Rockridge Rd Ste 110
Englewood, OH 45322-2794
Phone (937) 836-9921

Other practice location 8

1425 N. Fairfield Rd.
Ste 110
Breavercreek, OH 45432
Phone (937) 426-0106

Other practice location 9

1425 N. Fairfield Rd.
Ste 120
Beavercreek, OH 45432
Phone (937) 320-3888

Other practice location 10

3080 Ackerman Blvd Ste 220
Dayton, OH 45429-3658
Phone (937) 534-4201

Other practice location 11

6551 Centerville Business Parkway
Pediatrics Ste 110
Dayton, OH 45459-2686
Phone (937) 291-6850

Other identifiers 3

IdentifierTypeStateIssuer
=========OtherTRICARE GROUP NUMBER
2112958MedicaidOH
CA2478OtherOHMEDICARE RR

Other names 1

  • PriMed Physicians Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040409000393 OH Part B Supplier - Clinic/Group Practice 9032101399 Receives reassigned benefits from 27 practitioners
19 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dayton, OH; Kettering, OH; Englewood, OH; Beavercreek, OH

Other NPIs on the same Medicare enrollment 19

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

View all 19

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D0348293Premier Integrated Medical200 Rockridge Rd, Englewood, OH 45322Certificate of waiverNov 23, 2026
36D0350269Premier Integrated Medical6551 Centerville Business Parkway, Dayton, OH 45459Certificate of waiverOct 23, 2026
36D0941912Primed Physicians Patterson Woods1900 Composite Drive, Kettering, OH 45420Certificate of waiverJun 14, 2027

National Provider Directory

National Provider Directory
Tax ID family
Premier Integrated Medi7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3080 Ackerman Blvd
Ste 215
Dayton, OH 45429
Phone (937) 534-4201

8510 Old Troy Pike Ste 220
Dayton, OH 45424

6551 Centerville Business Pkwy
Dayton, OH 45459
Phone (937) 291-6850

1152 W 3rd St
Ste 101
Dayton, OH 45402

1900 Composite Dr
Kettering, OH 45420
Phone (937) 293-8419

3333 W Tech Rd
Ste 120
Miamisburg, OH 45342
Phone (937) 748-6116

2921 Springboro W Ste 201
Moraine, OH 45439

Practitioners & affiliated clinicians

Practitioners 35

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

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670630400000",
    "number": "1285690339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 COMPOSITE DR",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454201475",
            "telephone_number": "937-293-8419",
            "fax_number": "937-293-1545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 COMPOSITE DR",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454201475",
            "telephone_number": "937-293-8419",
            "fax_number": "937-293-1545"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3080 Ackerman Blvd Ste 215",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454293658",
            "country_code": "US",
            "telephone_number": "937-534-4201",
            "fax_number": "937-534-4237",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3080 Ackerman Blvd Ste 210",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454293658",
            "country_code": "US",
            "telephone_number": "937-534-4201",
            "fax_number": "937-534-4237",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "948 Patterson Rd",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454194336",
            "country_code": "US",
            "telephone_number": "937-320-3888",
            "fax_number": "937-320-3848",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 Rockridge Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Englewood",
            "state": "OH",
            "postal_code": "453222748",
            "country_code": "US",
            "telephone_number": "937-274-2117",
            "fax_number": "937-274-9809",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3333 W Tech Blvd Ste 120",
            "address_purpose": "LOCATION",
            "city": "Miamisburg",
            "state": "OH",
            "postal_code": "453420956",
            "country_code": "US",
            "telephone_number": "937-748-6116",
            "fax_number": "937-291-6956",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6551 Centerville Business Parkway",
            "address_2": "Family Practice Ste 100",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454592686",
            "country_code": "US",
            "telephone_number": "937-291-6830",
            "fax_number": "937-291-6893",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 Rockridge Rd Ste 110",
            "address_purpose": "LOCATION",
            "city": "Englewood",
            "state": "OH",
            "postal_code": "453222794",
            "country_code": "US",
            "telephone_number": "937-836-9921",
            "fax_number": "937-836-1298",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1425 N. Fairfield Rd.",
            "address_2": "Ste 110",
            "address_purpose": "LOCATION",
            "city": "Breavercreek",
            "state": "OH",
            "postal_code": "45432",
            "country_code": "US",
            "telephone_number": "937-426-0106",
            "fax_number": "937-426-7153",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1425 N. Fairfield Rd.",
            "address_2": "Ste 120",
            "address_purpose": "LOCATION",
            "city": "Beavercreek",
            "state": "OH",
            "postal_code": "45432",
            "country_code": "US",
            "telephone_number": "937-320-3888",
            "fax_number": "937-320-3848",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3080 Ackerman Blvd Ste 220",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454293658",
            "country_code": "US",
            "telephone_number": "937-534-4201",
            "fax_number": "937-534-4237",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6551 Centerville Business Parkway",
            "address_2": "Pediatrics Ste 110",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454592686",
            "country_code": "US",
            "telephone_number": "937-291-6850",
            "fax_number": "937-291-6896",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PREMIER INTEGRATED MEDICAL ASSOC LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "last_updated": "2022-12-10",
        "certification_date": "2022-12-10",
        "status": "A",
        "authorized_official_last_name": "COUCH",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "937-898-3600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE GROUP NUMBER",
            "identifier": "=========",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2112958",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "CA2478",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PriMed Physicians",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PriMed Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kettering, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2022; 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.