Active NPI
Jonathan F. Diller, M.D.
- Family Medicine Physician
- Fremont, OH
National Provider Identifier
1639130164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 35-045285
- Practice address
- 1479 N River Rd
Fremont, OH 43420 - Phone
- (419) 332-9978
- Fax
- (419) 332-7989
- NPI assigned
- Apr 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 35-045285 | OH | Primary |
Addresses
Primary practice location
1479 N River Rd
Fremont, OH 43420
Mailing address
PO Box 378
Sandusky, OH 44871-0378
Phone (419) 609-1112
Other practice location 1
2575 Hayes Ave
Suite 4
Fremont, OH 43420-5201
Phone (419) 332-9978
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000110993 | Other | OH | ANTHEM |
| 0437049 | Medicaid | OH | |
| 0004312244 | Other | OH | AETNA |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35-045285 | OH | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143849600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528243200000",
"number": "1639130164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 378",
"city": "SANDUSKY",
"state": "OH",
"postal_code": "448710378",
"telephone_number": "419-609-1112",
"fax_number": "419-609-1123"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1479 N RIVER RD",
"city": "FREMONT",
"state": "OH",
"postal_code": "43420",
"telephone_number": "419-332-9978",
"fax_number": "419-332-7989"
}
],
"practiceLocations": [
{
"address_1": "2575 Hayes Ave",
"address_2": "Suite 4",
"address_purpose": "LOCATION",
"city": "Fremont",
"state": "OH",
"postal_code": "434205201",
"country_code": "US",
"telephone_number": "419-332-9978",
"fax_number": "419-332-7989",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DILLER",
"first_name": "JONATHAN",
"middle_name": "F.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-01",
"last_updated": "2018-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OH",
"license": "35-045285",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000110993",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0437049",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0004312244",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fremont, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.