Individual provider Active NPI

Brandon Wolters

  • Student in an Organized Health Care Education/Training Program
  • Dayton, OH
National Provider Identifier
1467204040
Registry record updated Apr 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1 Wyoming Street, Bg020
Dayton, OH 45409
Phone
(937) 208-2850
NPI assigned
Apr 4, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

1 Wyoming Street, Bg020
Dayton, OH 45409

Mailing address

1 Wyoming Street, Bg020
Dayton, OH 45409
Phone (937) 208-2850

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
I20240604000663 OH Order and Referring Only - Obstetrics/GynecologyPractitioner - Obstetrics/Gynecology 1254873482

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1712188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712188800000",
    "number": "1467204040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 WYOMING STREET, BG020",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "45409",
            "telephone_number": "937-208-2850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WYOMING STREET, BG020",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "45409",
            "telephone_number": "937-208-2850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLTERS",
        "first_name": "BRANDON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-04-04",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.