NPIMap

Individual provider Active NPI

Vlada W Mardovin, M.D.

  • Specialist
  • Springfield, OH
National Provider Identifier
1437224508
Registry record updated Jan 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
35069608 Issued in OH
Practice address
1164 E Home Rd
Springfield, OH 45503-2726
Phone
(937) 342-9260
Fax
(937) 342-9262
NPI assigned
Nov 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 35069608 OH Primary

Addresses

Primary practice location

1164 E Home Rd
Springfield, OH 45503-2726

Mailing address

1164 E Home Rd
Suite J
Springfield, OH 45503-2726
Phone (937) 342-9260

Other identifiers 5

IdentifierTypeStateIssuer
MA4047453OtherOHOTHER MEDICARE LOCATION
1900693OtherUNITED HEALTHCARE
0007490231OtherOHAETNA
0267358MedicaidOH
340018970OtherRR MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060118001071 OH Practitioner - Urology 4789608621 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Wright State University Boonshoft School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Springfield Urology LLCGroup PAC ID 6608977459, 9 clinicians

Practice addresses (Care Compare)

1164 E Home Rd
Suite J
Springfield, OH 45503-2726
Phone (937) 342-9260

Hospital & facility affiliations

  • Ohio Valley Surgical Hospital Hospital, Springfield, OH, CCN 360355
  • Springfield Regional Medical Center Hospital, Springfield, OH, CCN 360086
  • Mercy Health - Urbana Hospital Hospital, Urbana, OH, CCN 361312
  • Soin Medical Center Hospital, Beaver Creek, OH, CCN 360360
  • Mary Rutan Hospital Hospital, Bellefontaine, OH, CCN 360197

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35069608OHMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Springfield Urology LLC CurrentSince Apr 1, 2007 Accepting new patients
Springfield Urology LLC Current Accepting new patients
Ohio Valley Medical Center, LLC Current Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Northwest Columbus Urology, Inc. Specialist Past Accepting new patients

Locations

498 London Ave
Ste H
Marysville, OH 43040
Phone (937) 644-5240

1164 E Home Rd
Ste 108
Springfield, OH 45503
Phone (937) 342-9260

1164 E Home Rd
Springfield, OH 45503
Phone (937) 342-9260

1164 E Home Rd
Ste J
Springfield, OH 45503
Phone (937) 342-9260

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: vlada.mardovin.p2@direct.springfieldurology.nextgenshare.com
  • Direct secure messaging: vmardovin@direct.ovsurgical.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Ohio Valley Surgical HospitalSpringfield, OH, CCN 360355 Hospital Corporate Director Jan 1, 2014

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294185600000",
    "number": "1437224508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1164 E HOME RD",
            "address_2": "SUITE J",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455032726",
            "telephone_number": "937-342-9260",
            "fax_number": "937-342-9262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1164 E HOME RD",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455032726",
            "telephone_number": "937-342-9260",
            "fax_number": "937-342-9262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARDOVIN",
        "first_name": "VLADA",
        "middle_name": "W",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-22",
        "last_updated": "2011-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OH",
            "license": "35069608",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER MEDICARE LOCATION",
            "identifier": "MA4047453",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1900693",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0007490231",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0267358",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "340018970",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, OH

Sources for this page

Verify at the official NPI Registry.