NPIMap

Individual provider Active NPI

Timothy Nicholas Wourms, M.D.

  • Family Medicine Physician
  • Middletown, OH
National Provider Identifier
1558447573
Registry record updated Nov 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35071942 Issued in OH
Practice address
1010 Summit Dr
Middletown, OH 45042-2926
Phone
(513) 424-0122
NPI assigned
Oct 31, 2006
Last updated
Nov 12, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 12, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35071942 OH Primary

Addresses

Primary practice location

1010 Summit Dr
Middletown, OH 45042-2926

Mailing address

1010 Summit Dr
Middletown, OH 45042-2926
Phone (513) 424-0122

Other identifiers 1

IdentifierTypeStateIssuer
2069292MedicaidOH

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address twourms207012@direct.ketteringhealth.org
FHIR URL https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101208000362 OH Practitioner - Family Practice 6002003654 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alliance Physicians IncGroup PAC ID 0840104360, 314 clinicians

Practice addresses (Care Compare)

1010 Summit Dr
Middletown, OH 45042-3400
Phone (513) 424-0122

1625 S Alex Rd
West Carrollton, OH 45449-5404
Phone (937) 865-0534

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35071942OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Physicians Inc Family Medicine CurrentSince Jul 1, 2020 Accepting new patients

Locations

1010 Summit Dr
Middletown, OH 45042
Phone (513) 424-0122

1625 S Alex Rd
West Carrollton, OH 45449
Phone (937) 865-0534

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605139200000",
    "number": "1558447573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 SUMMIT DR",
            "city": "MIDDLETOWN",
            "state": "OH",
            "postal_code": "450422926",
            "telephone_number": "513-424-0122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 SUMMIT DR",
            "city": "MIDDLETOWN",
            "state": "OH",
            "postal_code": "450422926",
            "telephone_number": "513-424-0122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOURMS",
        "first_name": "TIMOTHY",
        "middle_name": "NICHOLAS",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-31",
        "last_updated": "2020-11-12",
        "certification_date": "2020-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35071942",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2069292",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "twourms207012@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "1010 Summit Dr",
            "city": "middletown",
            "state": "OH",
            "country_code": "US",
            "postal_code": "450422926",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "1010 Summit Dr",
            "city": "middletown",
            "state": "OH",
            "country_code": "US",
            "postal_code": "450422926",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Middletown, OH

Sources for this page

Verify at the official NPI Registry.