NPIMap

Organization Active NPI

Synergy Medical, LLC

  • General Practice Physician
  • Marysville, OH
National Provider Identifier
1457887705
Registry record updated May 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
SYNERGY MEDICAL, LLC
Practice address
16705 Square Dr
Marysville, OH 43040-8476
Phone
(937) 642-4400
NPI assigned
May 5, 2017
Last updated
May 5, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2017

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

Authorized official

Name
Charita Nicole CooperNPI 1689606436
Title
Ceo
Phone
(937) 642-4400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

16705 Square Dr
Marysville, OH 43040-8476

Mailing address

16705 Square Dr
Marysville, OH 43040-8476
Phone (937) 642-4400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171019000712 OH Part B Supplier - Clinic/Group Practice 8325314354 Receives reassigned benefits from 9 practitioners
Practice locations: Marysville, OH

National Provider Directory

National Provider Directory

Locations

16705 Square Dr
Marysville, OH 43040
Phone (937) 400-2011

Practitioners & affiliated clinicians

Practitioners 9

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": "1493942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493942400000",
    "number": "1457887705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16705 SQUARE DR",
            "city": "MARYSVILLE",
            "state": "OH",
            "postal_code": "430408476",
            "telephone_number": "937-642-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16705 SQUARE DR",
            "city": "MARYSVILLE",
            "state": "OH",
            "postal_code": "430408476",
            "telephone_number": "937-642-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYNERGY MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-05",
        "last_updated": "2017-05-05",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "CHARITA",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "937-642-4400"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marysville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2017; 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.