NPIMap

Organization Active NPI

Premier Integrated Medical Assoc LTD

Doing business as PriMed Physicians

  • Internal Medicine Physician
  • Kettering, OH
National Provider Identifier
1417915224
Registry record updated Aug 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PREMIER INTEGRATED MEDICAL ASSOC LTD
Doing business as
PriMed Physicians
Practice address
540 Lincoln Park Blvd
Suite 390
Kettering, OH 45429-6401
Phone
(937) 312-8150
Fax
(937) 312-8151
NPI assigned
May 2, 2006
Last updated
Aug 12, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2011

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

Authorized official

Name
Dr. Mark A Couch, MDNPI 1548224314
Title
President
Phone
(937) 898-3600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary
Rheumatology Physician 207RR0500X NU

Addresses

Primary practice location

540 Lincoln Park Blvd
Suite 390
Kettering, OH 45429-6401

Mailing address

4700 Smith Rd
Suite a
Cincinnati, OH 45212-2787
Phone (513) 619-6819

Other identifiers 1

IdentifierTypeStateIssuer
2691529MedicaidOH

Other names 1

  • PriMed Physicians Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040409000393 OH Part B Supplier - Clinic/Group Practice 9032101399 Receives reassigned benefits from 27 practitioners
19 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dayton, OH; Kettering, OH; Englewood, OH; Beavercreek, OH

Other NPIs on the same Medicare enrollment 19

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

View all 19

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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": "1146528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313107200000",
    "number": "1417915224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 SMITH RD",
            "address_2": "SUITE A",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452122787",
            "telephone_number": "513-619-6819",
            "fax_number": "513-645-2393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 LINCOLN PARK BLVD",
            "address_2": "SUITE 390",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454296401",
            "telephone_number": "937-312-8150",
            "fax_number": "937-312-8151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER INTEGRATED MEDICAL ASSOC LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-02",
        "last_updated": "2011-08-12",
        "status": "A",
        "authorized_official_last_name": "COUCH",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "937-898-3600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2691529",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PriMed Physicians",
            "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 Aug 12, 2011; 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.