Individual provider Active NPI

Steven R Sutherin, MD

  • Surgery Physician
  • Dayton, OH
National Provider Identifier
1417917030
Registry record updated Nov 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
35051328 Issued in OH
Practice address
2350 Miami Valley Dr
Suite 400
Dayton, OH 45459-4778
Phone
(937) 228-1731
Fax
(937) 228-8622
NPI assigned
Mar 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 35051328 OH Primary

Addresses

Primary practice location

2350 Miami Valley Dr
Suite 400
Dayton, OH 45459-4778

Mailing address

2350 Miami Valley Dr
Suite 400
Dayton, OH 45459-4778
Phone (937) 228-1731

Other identifiers 1

IdentifierTypeStateIssuer
0705571MedicaidOH

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
I20110113001156 OH Practitioner - General Surgery 2264621721 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35051328OHMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Health Specialists Inc CurrentSince Aug 1, 2012 Accepting new patients
Surgical Consultants of Dayton Inc Current Accepting new patients
Premier Health Specialists Inc Surgery CurrentSince Aug 1, 2012 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Major Hospital Past Accepting new patients

Locations

2350 Miami Valley Dr
Ste 400
Dayton, OH 45459
Phone (937) 228-1731

30 E Apple St
#6258
Dayton, OH 45409
Phone (937) 208-5300

1222 S Patterson Blvd
Ste 120
Dayton, OH 45402
Phone (937) 208-8885

3170 Kettering Blvd
Bldg B
Moraine, OH 45439
Phone (937) 991-3187

450 N Hyatt St
Ste 304
Tipp City, OH 45371
Phone (937) 832-4773

Organizations & group practices 5

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": "1143417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384992000000",
    "number": "1417917030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2350 MIAMI VALLEY DR",
            "address_2": "SUITE 400",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454594778",
            "telephone_number": "937-228-1731",
            "fax_number": "937-228-8622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2350 MIAMI VALLEY DR",
            "address_2": "SUITE 400",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454594778",
            "telephone_number": "937-228-1731",
            "fax_number": "937-228-8622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTHERIN",
        "first_name": "STEVEN",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-27",
        "last_updated": "2013-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "35051328",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0705571",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.