NPIMap

Organization Active NPI

Premier Integrated Medical Assoc LTD

  • Internal Medicine Physician
  • Miamisburg, OH
National Provider Identifier
1639136013
Registry record updated Dec 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PREMIER INTEGRATED MEDICAL ASSOC LTD
Practice address
4000 Miamisburg Centerville Rd
Suite 104
Miamisburg, OH 45342
Phone
(937) 859-1117
Fax
(937) 859-9038
NPI assigned
Apr 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2009

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

Authorized official

Name
Dr. Mark A Couch, MD
Title
President
Phone
(937) 898-3600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

4000 Miamisburg Centerville Rd
Suite 104
Miamisburg, OH 45342

Mailing address

4700 Smith Rd
Suite a
Cincinnati, OH 45212-2787
Phone (513) 619-6819

Other identifiers 3

IdentifierTypeStateIssuer
CA2478OtherMEDICARE RR GROUP NUMBER
2178558MedicaidOH
314422758001OtherTRICARE GROUP NUMBER

Other names 1

  • PriMed Physicians Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040409000393 OH Part B Supplier - Clinic/Group Practice 9032101399 Receives reassigned benefits from 27 practitioners
19 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dayton, OH; Kettering, OH; Englewood, OH; Beavercreek, OH

Other NPIs on the same Medicare enrollment 19

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

View all 19

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262131200000",
    "number": "1639136013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 SMITH RD",
            "address_2": "SUITE A",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452122787",
            "telephone_number": "513-619-6819",
            "fax_number": "513-645-2393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 MIAMISBURG CENTERVILLE RD",
            "address_2": "SUITE 104",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "45342",
            "telephone_number": "937-859-1117",
            "fax_number": "937-859-9038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER INTEGRATED MEDICAL ASSOC LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-28",
        "last_updated": "2009-12-30",
        "status": "A",
        "authorized_official_last_name": "COUCH",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "937-898-3600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR GROUP NUMBER",
            "identifier": "CA2478",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2178558",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE GROUP NUMBER",
            "identifier": "314422758001",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PriMed Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Miamisburg, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2009; 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.