NPIMap

Organization Active NPI

Middletown Medical Group,Inc.

  • Internal Medicine Physician
  • Middletown, OH
National Provider Identifier
1477533446
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MIDDLETOWN MEDICAL GROUP,INC.
Practice address
200 N Breiel Blvd
Middletown, OH 45042-3808
Phone
(513) 424-2535
Fax
(513) 424-0363
NPI assigned
Jan 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Paul Russell Jennewine, MD
Title
President
Phone
(513) 424-2535

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

200 N Breiel Blvd
Middletown, OH 45042-3808

Mailing address

6850 Sloebig Rd
Middletown, OH 45042-9448
Phone (513) 424-2535

Other identifiers 1

IdentifierTypeStateIssuer
2338625MedicaidOH

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1477533446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6850 SLOEBIG RD",
            "city": "MIDDLETOWN",
            "state": "OH",
            "postal_code": "450429448",
            "telephone_number": "513-424-2535",
            "fax_number": "513-424-0363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N BREIEL BLVD",
            "city": "MIDDLETOWN",
            "state": "OH",
            "postal_code": "450423808",
            "telephone_number": "513-424-2535",
            "fax_number": "513-424-0363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDDLETOWN MEDICAL GROUP,INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JENNEWINE",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "513-424-2535",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2338625",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Middletown, OH

Sources for this page

  • 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.