NPIMap

Organization Active NPI

Physicians' Billing of MGH

Doing business as Pence-Davis Medical Center

  • Family Medicine Physician
  • Swayzee, IN
National Provider Identifier
1588717813
Registry record updated Feb 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PHYSICIANS' BILLING OF MGH
Doing business as
Pence-Davis Medical Center
Practice address
2651 S 800 W
Swayzee, IN 46986-9615
Phone
(765) 922-7056
Fax
(765) 922-7059
NPI assigned
Jan 19, 2007
Last updated
Feb 19, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
MARION GENERAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 19, 2009

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

Authorized official

Name
Paul Usher L, FACHE, CPA, FHFMA
Title
President/Ceo
Phone
(765) 662-4776

Specialties & licenses 1

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

Addresses

Primary practice location

2651 S 800 W
Swayzee, IN 46986-9615

Mailing address

1251 W Kem Rd
Suite E
Marion, IN 46952-2555
Phone (765) 662-4133

Other identifiers 1

IdentifierTypeStateIssuer
100269250MedicaidIN

Other names 1

  • Pence-Davis Medical Center Doing business as

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
15D0952748Dba Pence-Davis Medical Center2651 S 800 W, Swayzee, IN 46986Certificate of waiverApr 2, 2028

National Provider Directory

National Provider Directory
Tax ID family
Jeffrey D Breckenridge19 organizations share this tax ID, including this one
Part of
Jeffrey D Breckenridge

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

Locations

2651 S 800 W
Ste A
Swayzee, IN 46986

NPI Registry JSON

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235001600000",
    "number": "1588717813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1251 W KEM RD",
            "address_2": "SUITE E",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469522555",
            "telephone_number": "765-662-4133",
            "fax_number": "765-165-1731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2651 S 800 W",
            "city": "SWAYZEE",
            "state": "IN",
            "postal_code": "469869615",
            "telephone_number": "765-922-7056",
            "fax_number": "765-922-7059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS' BILLING OF MGH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARION GENERAL HOSPITAL",
        "enumeration_date": "2007-01-19",
        "last_updated": "2009-02-19",
        "status": "A",
        "authorized_official_last_name": "L",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "USHER",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "765-662-4776",
        "authorized_official_credential": "FACHE, CPA, FHFMA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100269250",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pence-Davis Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Swayzee, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.