NPIMap

Organization Active NPI

Olentangy Pediatrics, Inc.

  • Pediatrics Physician
  • Columbus, OH
National Provider Identifier
1609842962
Registry record updated Jul 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
OLENTANGY PEDIATRICS, INC.
Practice address
4775 Knightsbridge Blvd
Suite 207
Columbus, OH 43214-4313
Phone
(614) 442-5557
Fax
(614) 442-1070
NPI assigned
Feb 27, 2006
Last updated
Jul 2, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2008

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

Authorized official

Name
Sherry V Robison
Title
Office Manager
Phone
(614) 442-9004

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

4775 Knightsbridge Blvd
Suite 207
Columbus, OH 43214-4313

Mailing address

4775 Knightsbridge Blvd
Suite 207
Columbus, OH 43214-4313
Phone (614) 442-5557

Other identifiers 4

IdentifierTypeStateIssuer
000000161624OtherOHANTHEM
5313391OtherOHAETNA
2557399MedicaidOH
074460OtherOHAETNA HMO

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
36D0704743Olentangy Pediatrics4775 Knightsbridge Blvd Ste 207, Columbus, OH 43214Certificate of waiverDec 22, 2027

National Provider Directory

National Provider Directory

Locations

4775 Knightsbridge Blvd
Ste 207
Columbus, OH 43214
Phone (614) 442-5557

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/6860/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214956800000",
    "number": "1609842962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4775 KNIGHTSBRIDGE BLVD",
            "address_2": "SUITE 207",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432144313",
            "telephone_number": "614-442-5557",
            "fax_number": "614-442-1070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4775 KNIGHTSBRIDGE BLVD",
            "address_2": "SUITE 207",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432144313",
            "telephone_number": "614-442-5557",
            "fax_number": "614-442-1070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLENTANGY PEDIATRICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-27",
        "last_updated": "2008-07-02",
        "status": "A",
        "authorized_official_last_name": "ROBISON",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "614-442-9004"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000161624",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5313391",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2557399",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "074460",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2008; 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.