Central Cincinnati Group Medical Practice

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

35-029778 Issued in OH

Legal business name

CENTRAL CINCINNATI GROUP MEDICAL PRACTICE

Practice address

791 E McMillan St
Cincinnati, OH 45206-1943

Phone

(513) 751-2221

Fax

(513) 751-8804

NPI assigned

Feb 20, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Charles O Dillard, M.D.

Title

President & Ceo

Phone

(513) 751-2221

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1437293545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "791 E MCMILLAN ST",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452061943",
            "telephone_number": "513-751-2221",
            "fax_number": "513-751-8804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "791 E MCMILLAN ST",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452061943",
            "telephone_number": "513-751-2221",
            "fax_number": "513-751-8804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL CINCINNATI GROUP MEDICAL PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DILLARD",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "513-751-2221",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35-029778",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0980694",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.