NPIMap

Individual provider Active NPI

Bruce Daniel Willner, DO

  • Family Medicine Physician
  • Youngstown, OH
National Provider Identifier
1609853076
Registry record updated Sep 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
34004681W Issued in OH
Practice address
3622 Belmont Ave
Ste 18
Youngstown, OH 44505-1444
Phone
(330) 759-8050
Fax
(330) 759-1246
NPI assigned
Dec 28, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 27, 2018

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 34004681W OH Primary

Addresses

Primary practice location

3622 Belmont Ave
Ste 18
Youngstown, OH 44505-1444

Mailing address

3622 Belmont Ave
Ste 18
Youngstown, OH 44505-1444
Phone (330) 759-8050

Other identifiers 1

IdentifierTypeStateIssuer
0791899MedicaidOH

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
I20101012000965 OH Practitioner - Family Practice 4880886670 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
New York College of Osteo Medicine of New York Institute of Technology, 1985
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

3622 Belmont Ave
Youngstown, OH 44505-1444
Phone (330) 759-8050

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Bruce Willner DO LLC Family Medicine CurrentSince Aug 24, 2018 Accepting new patients
Youngstown Area Jewish Federation Past Accepting new patients

Locations

3622 Belmont Ave
Ste 18
Youngstown, OH 44505
Phone (330) 759-4241

Interoperability endpoints

  • Direct secure messaging: bwillner34727@direct.bsmhealth.org

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Heritage ManorYoungstown, OH, CCN 365114 Skilled nursing facility Adp of the SNF Jul 1, 2004
Southerncare YoungstownYoungstown, OH, CCN 361617 Hospice Contracted Managing Employee May 25, 2016

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

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.

Hospital & facility affiliations 9

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": "1135728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538006400000",
    "number": "1609853076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3622 BELMONT AVE",
            "address_2": "STE 18",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445051444",
            "telephone_number": "330-759-8050",
            "fax_number": "330-759-1246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3622 BELMONT AVE",
            "address_2": "STE 18",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445051444",
            "telephone_number": "330-759-8050",
            "fax_number": "330-759-1246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLNER",
        "first_name": "BRUCE",
        "middle_name": "DANIEL",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-28",
        "last_updated": "2018-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "34004681W",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0791899",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Youngstown, OH

Sources for this page

Verify at the official NPI Registry.