NPIMap

Organization Active NPI

South Community Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Moraine, OH
National Provider Identifier
1639128176
Registry record updated May 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
0101 Issued in OH
Legal business name
SOUTH COMMUNITY INC
Practice address
3095 Kettering Blvd
Moraine, OH 45439
Phone
(937) 293-8300
Fax
(937) 534-1353
NPI assigned
May 10, 2006
Last updated
May 31, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2023

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

Authorized official

Name
Lisa CarterNPI 1639422207
Title
Ceo
Phone
(937) 293-8300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 0101 OH Primary

Addresses

Primary practice location

3095 Kettering Blvd
Moraine, OH 45439

Mailing address

3095 Kettering Blvd
Moraine, OH 45439
Phone (937) 293-8300

Other identifiers 2

IdentifierTypeStateIssuer
MC34-1000MedicaidOH
0320870MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050921001092 OH Part B Supplier - Clinic/Group Practice 7315971066 Receives reassigned benefits from 57 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Moraine, OH

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 52

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.

View all 52

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685491200000",
    "number": "1639128176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3095 KETTERING BLVD",
            "city": "MORAINE",
            "state": "OH",
            "postal_code": "45439",
            "telephone_number": "937-293-8300",
            "fax_number": "937-534-1353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3095 KETTERING BLVD",
            "city": "MORAINE",
            "state": "OH",
            "postal_code": "45439",
            "telephone_number": "937-293-8300",
            "fax_number": "937-534-1353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH COMMUNITY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2023-05-31",
        "certification_date": "2023-05-31",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "937-293-8300"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "OH",
            "license": "0101",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MC34-1000",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0320870",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moraine, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.