Active NPI
Destiny Surber
- Peer Specialist
- Columbus, OH
National Provider Identifier
1629644331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- Practice address
- 4000 E Main St
Columbus, OH 43213-2950 - Phone
- (614) 334-6903
- NPI assigned
- Jun 2, 2021
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | OH | Primary |
Addresses
Primary practice location
4000 E Main St
Columbus, OH 43213-2950
Mailing address
4000 E Main St
Columbus, OH 43213-2950
Phone (614) 334-6903
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0315095 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1622592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1622592000000",
"number": "1629644331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4000 E MAIN ST",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432132950",
"telephone_number": "614-334-6903"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4000 E MAIN ST",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432132950",
"telephone_number": "614-334-6903"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SURBER",
"first_name": "DESTINY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-02",
"last_updated": "2021-06-02",
"certification_date": "2021-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OH",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0315095",
"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 Jun 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.