Organization Active NPI

Gem City Primary Care LLC

  • Internal Medicine Physician
  • Dayton, OH
National Provider Identifier
1295410165
Registry record updated Aug 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
GEM CITY PRIMARY CARE LLC
Practice address
118 W 1St St Ste 800
Dayton, OH 45402-1150
Phone
(937) 345-1436
NPI assigned
Jun 19, 2023
Last updated
Aug 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2023

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

Authorized official

Name
Dr. Matthew Ryan Noordsij-Jones, MDNPI 1891911640
Title
Owner/Physician
Phone
(937) 321-8698

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X

Addresses

Primary practice location

118 W 1St St Ste 800
Dayton, OH 45402-1150

Mailing address

118 W 1St St Ste 800
Dayton, OH 45402-1150
Phone (937) 345-1436

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230715000325 OH Part B Supplier - Clinic/Group Practice 0446610943 Receives reassigned benefits from 2 practitioners
Practice locations: Dayton, OH

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
36D2284807Gem City Primary Care118 West 1St Street, Ste 800, Dayton, OH 45402Certificate of waiverJun 28, 2027

National Provider Directory

National Provider Directory

Locations

118 W 1st St
#800
Dayton, OH 45402

118 W 1st St
Ste 800
Dayton, OH 45402
Phone (937) 321-8698

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1687132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692576000000",
    "number": "1295410165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 W 1ST ST STE 800",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454021150",
            "telephone_number": "937-345-1436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 W 1ST ST STE 800",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454021150",
            "telephone_number": "937-345-1436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEM CITY PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-19",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A",
        "authorized_official_last_name": "NOORDSIJ-JONES",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "RYAN",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "937-321-8698",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 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.