Active NPI
Ambrose Steve Perduk Jr., DC
- Chiropractor
- Dover, OH
National Provider Identifier
1619931250
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 1155
- Practice address
- 125 West Second St
Dover, OH 44622 - Phone
- (330) 343-2621
- Fax
- (330) 343-2621
- NPI assigned
- Apr 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 1155 | OH | Primary |
Addresses
Primary practice location
125 West Second St
Dover, OH 44622
Mailing address
125 West Second St
Dover, OH 44622
Phone (330) 343-2621
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0707668 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Logan College of Chiropractic, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
125 W 2ND St
Dover, OH 44622-2931
Phone (330) 343-2621
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1155 | OH | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ambrose S Perduk Jr DC Inc | Chiropractor | Current | Accepting new patients |
Locations
125 W 2nd St
Dover, OH 44622
Phone (330) 343-2621
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 and National Provider Directory roles.
-
- Chiropractor
- Dover, OH
- NPI 1912112418
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1619931250",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "125 WEST SECOND ST",
"city": "DOVER",
"state": "OH",
"postal_code": "44622",
"telephone_number": "330-343-2621",
"fax_number": "330-343-6006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 WEST SECOND ST",
"city": "DOVER",
"state": "OH",
"postal_code": "44622",
"telephone_number": "330-343-2621",
"fax_number": "330-343-2621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERDUK",
"first_name": "AMBROSE",
"middle_name": "STEVE",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "OH",
"license": "1155",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0707668",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Dover, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.