NPIMap

Organization Active NPI

Woodman Primary Care LLC

  • Cardiovascular Disease Physician
  • Dayton, OH
National Provider Identifier
1346582608
Registry record updated Oct 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
WOODMAN PRIMARY CARE LLC
Practice address
1320 Woodman Dr
Dayton, OH 45432-3497
Phone
(937) 223-1781
Fax
(937) 424-8656
NPI assigned
Mar 25, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2013

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

Authorized official

Name
Jeffrey F KolaczkowskiNPI 1821070137
Title
Sole Owner
Phone
(937) 223-1781

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X Primary

Addresses

Primary practice location

1320 Woodman Dr
Dayton, OH 45432-3497

Mailing address

1320 Woodman Dr
Dayton, OH 45432-3497
Phone (937) 223-1781

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130815000922 OH Part B Supplier - Clinic/Group Practice 7416199799 Receives reassigned benefits from 10 practitioners
Practice locations: Dayton, OH

National Provider Directory

National Provider Directory

Locations

319 N Broad St
Fairborn, OH 45324

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1364169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381104000000",
    "number": "1346582608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 WOODMAN DR",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454323497",
            "telephone_number": "937-223-1781",
            "fax_number": "937-424-8656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 WOODMAN DR",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454323497",
            "telephone_number": "937-223-1781",
            "fax_number": "937-424-8656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODMAN PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-25",
        "last_updated": "2013-10-07",
        "status": "A",
        "authorized_official_last_name": "KOLACZKOWSKI",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "937-223-1781"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "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 Oct 7, 2013; 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.