Countryside Acute Care LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

COUNTRYSIDE ACUTE CARE LLC

Practice address

Main St
South Vienna, OH 45369

Phone

(937) 000-0000

NPI assigned

Jan 10, 2023

Organization subpart

No

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

Authorized official

Name

Mr. Derrick Marple, FNP, RN, PARAMEDIC

Title

Owner

Phone

(937) 605-9294

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1673308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683676800000",
    "number": "1548974009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "931 WILSON RD",
            "city": "SOUTH VIENNA",
            "state": "OH",
            "postal_code": "453699747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MAIN ST",
            "city": "SOUTH VIENNA",
            "state": "OH",
            "postal_code": "45369",
            "telephone_number": "937-000-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE ACUTE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-10",
        "last_updated": "2023-05-10",
        "certification_date": "2023-05-10",
        "status": "A",
        "authorized_official_last_name": "MARPLE",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "937-605-9294",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "FNP, RN, PARAMEDIC"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in South Vienna, OH
• Providers in South Vienna, OH by specialty
• Family Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2023; 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.