Individual provider Active NPI

Walter Jonathan Friedley, MD

  • Pediatrics Physician
  • Marion, OH
National Provider Identifier
1518925072
Registry record updated Dec 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
35.079367 Issued in OH
Practice address
1040 Delaware Aveneue
Marion, OH 43301-1814
Phone
(740) 383-8090
Fax
(740) 375-6481
NPI assigned
May 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 35.079367 OH Primary

Addresses

Primary practice location

1040 Delaware Aveneue
Marion, OH 43301-1814

Mailing address

L-3549
Columbus, OH 43260-0001
Phone (740) 383-7927

Other identifiers 8

IdentifierTypeStateIssuer
2244360MedicaidOH
311098079OtherTAX ID
1202702OtherUHC
7052274OtherAETNA
353077OtherSUBMITTER NO
000000202163OtherANTHEM
311090079OtherCIGNA
370018677OtherTRAVELERS MEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address wfriedley107189@direct.ohiohealth.com OhioHealth Physician Group

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
I20091117000569 OH Practitioner - Pediatric Medicine 0749362184 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35.079367OHMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Marion Area Physicians LLC Pediatrics CurrentSince Oct 28, 2012 Accepting new patients

Locations

Dept L3652
Columbus, OH 43260

1040 Delaware Ave
Marion, OH 43302
Phone (330) 256-9874

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1518925072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "L-3549",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432600001",
            "telephone_number": "740-383-7927",
            "fax_number": "740-383-7942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 DELAWARE AVENEUE",
            "city": "MARION",
            "state": "OH",
            "postal_code": "433011814",
            "telephone_number": "740-383-8090",
            "fax_number": "740-375-6481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRIEDLEY",
        "first_name": "WALTER",
        "middle_name": "JONATHAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35.079367",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2244360",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "311098079",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "1202702",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7052274",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUBMITTER NO",
            "identifier": "353077",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000202163",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "311090079",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRAVELERS MEDICARE",
            "identifier": "370018677",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wfriedley107189@direct.ohiohealth.com",
            "affiliation": "Y",
            "affiliationName": "OhioHealth Physician Group",
            "address_1": "1040 Delaware Ave",
            "city": "Marion",
            "state": "OH",
            "country_code": "US",
            "postal_code": "433026416",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marion, OH

Sources for this page

Verify at the official NPI Registry.