NPIMap

Organization Active NPI

Promedica Central Physicians LLC

Doing business as ProMedica Children's Specialties

  • Pediatric Pulmonology Physician
  • Sandusky, OH
National Provider Identifier
1518202050
Registry record updated Feb 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Pulmonology PhysicianTaxonomy code 2080P0214X
Legal business name
PROMEDICA CENTRAL PHYSICIANS LLC
Doing business as
ProMedica Children's Specialties
Practice address
1912 Hayes Ave
Sandusky, OH 44870-4736
Phone
(419) 557-6767
Fax
(419) 557-6783
NPI assigned
Dec 11, 2012
Last updated
Feb 5, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2021

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

Authorized official

Name
Kristin Knueven
Title
Credentialing Supervisor
Phone
(567) 585-1969

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Critical Care Medicine Physician 2080P0203X OH
Pediatric Pulmonology Physician 2080P0214X OH Primary

Addresses

Primary practice location

1912 Hayes Ave
Sandusky, OH 44870-4736

Mailing address

1912 Hayes Ave
Sandusky, OH 44870-4736
Phone (419) 557-6767

Other names 1

  • ProMedica Children's Specialties Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Promedica Central Phy LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1355184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612483200000",
    "number": "1518202050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1912 HAYES AVE",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448704736",
            "telephone_number": "419-557-6767",
            "fax_number": "419-557-6783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1912 HAYES AVE",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448704736",
            "telephone_number": "419-557-6767",
            "fax_number": "419-557-6783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMEDICA CENTRAL PHYSICIANS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-11",
        "last_updated": "2021-02-05",
        "certification_date": "2021-02-05",
        "status": "A",
        "authorized_official_last_name": "KNUEVEN",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "567-585-1969"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "OH",
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ProMedica Children's Specialties",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ProMedica Children's Specialties",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sandusky, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2021; 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.