Individual provider Active NPI

Ambrose Steve Perduk Jr., DC

  • Chiropractor
  • Dover, OH
National Provider Identifier
1619931250
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1155 Issued in OH
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

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
0707668MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091201000323 OH Practitioner - Chiropractic 6608915889 Reassigns benefits to 1 organization

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

LicenseStateTypeSpecialty
1155OHMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Ambrose S Perduk Jr DC Inc Chiropractor CurrentSince Sep 30, 1981 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.

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.

Verify at the official NPI Registry.