Individual provider Active NPI

Manuel Alvarez Jr., PA-C

  • Physician Assistant
  • Centerville, OH
National Provider Identifier
1548828825
Registry record updated Jan 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50-005967 Issued in OH
Practice address
2350 Miami Valley Dr Ste 500
Centerville, OH 45459-4780
Phone
(937) 293-1622
Fax
(937) 245-6308
NPI assigned
Jun 3, 2019
Last updated
Jan 7, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50-005967 OH Primary

Addresses

Primary practice location

2350 Miami Valley Dr Ste 500
Centerville, OH 45459-4780

Mailing address

6680 Poe Ave Ste 200
Dayton, OH 45414-2855
Phone (937) 280-8400

Other practice location 1

9000 N Main St Ste 200
Englewood, OH 45415-1165
Phone (937) 293-1622

Other identifiers 1

IdentifierTypeStateIssuer
0359800MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address malvarez1378883@direct.premierhealth.com

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190717001542 OH Practitioner - Physician Assistant 3779818406 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
50-005967OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dayton Physicians, LLC CurrentSince Jun 10, 2019 Accepting new patients
Dayton Physicians, LLC CurrentSince Jun 10, 2019 Accepting new patients

Locations

1 Wyoming St
Dayton, OH 45409
Phone (937) 208-2636

2350 Miami Valley Dr
Ste 500
Dayton, OH 45459
Phone (937) 425-0003

6680 Poe Ave
Ste 200
Dayton, OH 45414

9000 N Main St
Ste 200
Englewood, OH 45415
Phone (937) 495-0000

9000 N Main St
Ste G-36
Englewood, OH 45415
Phone (937) 832-1093

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1559520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641513600000",
    "number": "1548828825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6680 POE AVE STE 200",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454142855",
            "telephone_number": "937-280-8400",
            "fax_number": "937-280-8373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2350 MIAMI VALLEY DR STE 500",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454594780",
            "telephone_number": "937-293-1622",
            "fax_number": "937-245-6308"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9000 N Main St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Englewood",
            "state": "OH",
            "postal_code": "454151165",
            "country_code": "US",
            "telephone_number": "937-293-1622",
            "fax_number": "937-245-6308",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ALVAREZ",
        "first_name": "MANUEL",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-03",
        "last_updated": "2022-01-07",
        "certification_date": "2022-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50-005967",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0359800",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "malvarez1378883@direct.premierhealth.com",
            "affiliation": "N",
            "address_1": "2350 Miami Valley Dr Ste 500",
            "city": "Centerville",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454594780",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Centerville, OH

Sources for this page

Verify at the official NPI Registry.