Individual provider Active NPI

Michael A. Wodarcyk, M.D.

  • Urology Physician
  • Gahanna, OH
National Provider Identifier
1407827264
Registry record updated Feb 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
35059868 Issued in OH
Practice address
701 Tech Center Dr
Gahanna, OH 43230-1987
Phone
(614) 396-2684
Fax
(614) 396-2480
NPI assigned
Jan 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 35059868 OH Primary

Addresses

Primary practice location

701 Tech Center Dr
Gahanna, OH 43230-1987

Mailing address

701 Tech Center Dr Ste 250
Gahanna, OH 43230-1987
Phone (614) 396-2684

Other identifiers 2

IdentifierTypeStateIssuer
0803867MedicaidOH
0335453OtherOHRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060803000286 OH Practitioner - Urology 9830160506 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35059868OHMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Ohio Urology Group, LLC Urology CurrentSince Sep 1, 2006 Accepting new patients
Central Ohio Urology Group, LLC Urology CurrentSince Sep 1, 2006 Accepting new patients
Buckeye Urology and Andrology, Inc Urology PastSince Jan 1, 1992 Accepting new patients

Locations

5969 E Broad St
Ste 407
Columbus, OH 43213
Phone (614) 755-2290

8200 Hazelton Etna Rd SW
Etna, OH 43062
Phone (614) 221-5189

701 Tech Center Dr
Ste 250
Gahanna, OH 43230

701 Tech Center Dr
Gahanna, OH 43230
Phone (614) 944-4806

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581552000000",
    "number": "1407827264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 TECH CENTER DR STE 250",
            "city": "GAHANNA",
            "state": "OH",
            "postal_code": "432301987",
            "telephone_number": "614-396-2684",
            "fax_number": "614-396-2480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 TECH CENTER DR",
            "city": "GAHANNA",
            "state": "OH",
            "postal_code": "432301987",
            "telephone_number": "614-396-2684",
            "fax_number": "614-396-2480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WODARCYK",
        "first_name": "MICHAEL",
        "middle_name": "A.",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-30",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "OH",
            "license": "35059868",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0803867",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "0335453",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gahanna, OH

Sources for this page

Verify at the official NPI Registry.