Individual provider Active NPI

James Michael Pacenta, MD

  • Interventional Cardiology Physician
  • Dayton, OH
National Provider Identifier
1558360016
Registry record updated Feb 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
35.051955 Issued in OH
Practice address
122 Wyoming St
Dayton, OH 45409-2731
Phone
(937) 223-4461
Fax
(937) 224-1945
NPI assigned
Jul 18, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 35051955 OH
Interventional Cardiology Physician 207RI0011X 35.051955 OH Primary

Addresses

Primary practice location

122 Wyoming St
Dayton, OH 45409-2731

Mailing address

122 Wyoming St
Dayton, OH 45409-2731
Phone (937) 223-4461

Other identifiers 2

IdentifierTypeStateIssuer
0589199MedicaidOH
000000005802OtherOHANTHEM

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
I20091027000449 OH Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology) 6709877350 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35051955OHMDCardiovascular Disease Physician
35.051955OHMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Health Specialists Inc Cardiovascular Disease CurrentSince Oct 1, 2009 Accepting new patients
Premier Health Specialists Inc CurrentSince Oct 1, 2009 Accepting new patients
Premier Health Specialists Inc Cardiovascular Disease Current Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Miami Valley Cardiologists Inc. Cardiovascular Disease PastSince Jul 14, 2003 Accepting new patients

Locations

122 Wyoming St
Dayton, OH 45409
Phone (937) 438-8640

30 E Apple St
#6258
Dayton, OH 45409
Phone (937) 208-5300

3170 Kettering Blvd
Bldg B
Moraine, OH 45439
Phone (937) 991-3187

450 N Hyatt St
Ste 304
Tipp City, OH 45371
Phone (937) 832-4773

Organizations & group practices 5

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": "1121644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485993600000",
    "number": "1558360016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 WYOMING ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454092731",
            "telephone_number": "937-223-4461",
            "fax_number": "937-224-1945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 WYOMING ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454092731",
            "telephone_number": "937-223-4461",
            "fax_number": "937-224-1945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACENTA",
        "first_name": "JAMES",
        "middle_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-18",
        "last_updated": "2017-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OH",
            "license": "35051955",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "OH",
            "license": "35.051955",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0589199",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000005802",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.