NPIMap

Organization Active NPI

Alliance Physicians Inc

Doing business as South Dayton Urology

  • Urology Physician
  • Kettering, OH
National Provider Identifier
1306128608
Registry record updated Oct 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
ALLIANCE PHYSICIANS INC
Doing business as
South Dayton Urology
Practice address
10 Southmoor Cir NW
Kettering, OH 45429-2486
Phone
(937) 294-1489
Fax
(937) 297-6468
NPI assigned
Sep 13, 2011
Last updated
Oct 4, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
ALLIANCE PHYSICIAN INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 4, 2019

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

Authorized official

Name
Timothy Y Ko
Title
Cfo
Phone
(937) 558-3223

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X Primary

Addresses

Primary practice location

10 Southmoor Cir NW
Kettering, OH 45429-2486

Mailing address

10050 Innovation Dr
Suite 200
Miamisburg, OH 45342-4931
Phone (937) 558-3208

Other names 1

  • South Dayton Urology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031118000529 OH Part B Supplier - Clinic/Group Practice 0840104360 Receives reassigned benefits from 528 practitioners
25 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 25

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

View all 25

National Provider Directory

National Provider Directory
Part of
Alliance Phyisicans Inc

Practitioners & affiliated clinicians

Practitioners 10

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": "1315872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570147200000",
    "number": "1306128608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10050 INNOVATION DR",
            "address_2": "SUITE 200",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453424931",
            "telephone_number": "937-558-3208",
            "fax_number": "937-558-3247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 SOUTHMOOR CIR NW",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454292486",
            "telephone_number": "937-294-1489",
            "fax_number": "937-297-6468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIANCE PHYSICIANS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALLIANCE PHYSICIAN INC",
        "enumeration_date": "2011-09-13",
        "last_updated": "2019-10-04",
        "status": "A",
        "authorized_official_last_name": "KO",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "937-558-3223"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Dayton Urology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Dayton Urology",
            "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 Oct 4, 2019; 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.

Verify at the official NPI Registry.