NPIMap

Organization Active NPI

Lebanon Medical Center, Inc

  • Internal Medicine Physician
  • Lebanon, OH
National Provider Identifier
1295717601
Registry record updated May 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
207R00000X Issued in OH
Legal business name
LEBANON MEDICAL CENTER, INC
Doing business as
Lebanon Medical Center, Inc.
Practice address
990 Belvedere Dr Ste a
Lebanon, OH 45036-2890
Phone
(513) 228-1666
Fax
(513) 228-1555
NPI assigned
Nov 20, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2012

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

Authorized official

Name
Dr. Madhumathi Kosaraju, M.D.
Title
President
Phone
(513) 228-1666

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 207R00000X OH Primary

Addresses

Primary practice location

990 Belvedere Dr Ste a
Lebanon, OH 45036-2890

Mailing address

7661 Brookfarm CT
Mason, OH 45040-7027
Phone (513) 398-7376

Other identifiers 4

IdentifierTypeStateIssuer
P00219908OtherOHRAILROAD MEDICARE
2545857MedicaidOH
378156491001OtherOHMEDICAL MUTUAL OF OHIO
378156495-00OtherOHOHIO BWC

Other names 1

  • Lebanon Medical Center, Inc. Doing business as

National Provider Directory

National Provider Directory

Locations

900 Belevedere Dr a
Lebanon, OH 45036
Phone (513) 509-1350

900 Belevedere Dr a
Lebanon, OH 45036
Phone (513) 228-1666

NPI Registry JSON

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

{
    "created_epoch": "1132444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336780800000",
    "number": "1295717601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7661 BROOKFARM CT",
            "city": "MASON",
            "state": "OH",
            "postal_code": "450407027",
            "telephone_number": "513-398-7376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 BELVEDERE DR STE A",
            "city": "LEBANON",
            "state": "OH",
            "postal_code": "450362890",
            "telephone_number": "513-228-1666",
            "fax_number": "513-228-1555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEBANON MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-20",
        "last_updated": "2012-05-12",
        "status": "A",
        "authorized_official_last_name": "KOSARAJU",
        "authorized_official_first_name": "MADHUMATHI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "513-228-1666",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "207R00000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00219908",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2545857",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL MUTUAL OF OHIO",
            "identifier": "378156491001",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO BWC",
            "identifier": "378156495-00",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lebanon Medical Center, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lebanon, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.