Organization Active NPI

Mvhe Inc

Doing business as Beavercreek Family Medicine

  • Family Medicine Physician
  • Beavercreek, OH
National Provider Identifier
1558313460
Registry record updated Nov 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MVHE INC
Doing business as
Beavercreek Family Medicine
Practice address
111 Harbert Dr
Beavercreek, OH 45440-5117
Phone
(937) 208-7575
Fax
(937) 208-7590
NPI assigned
May 17, 2006
Last updated
Nov 6, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
MVHE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 6, 2013

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

Authorized official

Name
Kenneth Prunier
Title
Ceo/President
Phone
(937) 208-8213

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

111 Harbert Dr
Beavercreek, OH 45440-5117

Mailing address

111 Harbert Dr
Beavercreek, OH 45440-5117
Phone (937) 208-7575

Other identifiers 1

IdentifierTypeStateIssuer
2018097MedicaidOH

Other names 1

  • Beavercreek Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031217000553 OH Part B Supplier - Clinic/Group Practice 9537066584 Receives reassigned benefits from 777 practitioners
47 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Franklin, OH; Huber Heights, OH; Jamestown, OH; Kettering, OH; Lebanon, OH; Liberty Township, OH; Middletown, OH; Monroe, OH…

Other NPIs on the same Medicare enrollment 47

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 47

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D0349940Beavercreek Family Medicine and Obstetrics111 Harbert Drive, Beavercreek, OH 45440Provider-performed microscopyJul 27, 2028

National Provider Directory

National Provider Directory
Part of
Comprehensive Primary C

Locations

111 Harbert Dr
Dayton, OH 45440
Phone (937) 208-7575

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383696000000",
    "number": "1558313460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 HARBERT DR",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454405117",
            "telephone_number": "937-208-7575",
            "fax_number": "937-208-7590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 HARBERT DR",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454405117",
            "telephone_number": "937-208-7575",
            "fax_number": "937-208-7590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MVHE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MVHE INC",
        "enumeration_date": "2006-05-17",
        "last_updated": "2013-11-06",
        "status": "A",
        "authorized_official_last_name": "PRUNIER",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "937-208-8213"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2018097",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beavercreek Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beavercreek, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.