NPIMap

Individual provider Active NPI

Gaetano Thomas Fazio Jr., M.D.

  • Family Medicine Physician
  • Springfield, OH
National Provider Identifier
1639142177
Registry record updated Jan 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35025852 Issued in OH
Practice address
2665 Derr Rd
Springfield, OH 45503-2445
Phone
(937) 342-9801
Fax
(937) 342-9804
NPI assigned
Feb 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35025852 OH Primary

Addresses

Primary practice location

2665 Derr Rd
Springfield, OH 45503-2445

Mailing address

2665 Derr Rd
Springfield, OH 45503-2445
Phone (937) 342-9820

Other identifiers 1

IdentifierTypeStateIssuer
2675654MedicaidOH

Other names 1

  • Dr. G Thomas Fazio Other name

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

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Service Associates of Xenia Inc Family Medicine Past Accepting new patients
Citran Xray LLC Past Accepting new patients
Community Urgent Care Inc. Past Accepting new patients
Taj Medical Inc Past Accepting new patients
State of Ohio Office of Budget and Management State Accounting Past Accepting new patients

Organizations & group practices 5

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": "1139270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389312000000",
    "number": "1639142177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2665 DERR RD",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455032445",
            "telephone_number": "937-342-9820",
            "fax_number": "937-342-9820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2665 DERR RD",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455032445",
            "telephone_number": "937-342-9801",
            "fax_number": "937-342-9804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAZIO",
        "first_name": "GAETANO",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-07",
        "last_updated": "2014-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35025852",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2675654",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "G",
            "last_name": "FAZIO",
            "middle_name": "THOMAS",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Springfield, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.