Individual provider Active NPI

Jack Butterfield, M.D.

  • Family Medicine Physician
  • Roseville, OH
National Provider Identifier
1639154495
Registry record updated Aug 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35045078 Issued in OH
Practice address
167 S Main St
Roseville, OH 43777-1284
Phone
(740) 697-7373
Fax
(740) 697-7683
NPI assigned
Dec 14, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2008

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 35045078 OH Primary

Addresses

Primary practice location

167 S Main St
Roseville, OH 43777-1284

Mailing address

860 Bethesda Dr
Zanesville, OH 43701-1800
Phone (740) 454-4651

Other identifiers 9

IdentifierTypeStateIssuer
080002140OtherOHMEDICARE RAILROAD
000000019419OtherOHANTHEM PIN
CA1586OtherGROUP MEDICARE RAILROAD
0989499OtherOHGROUP MEDICAID
000000177535OtherOHUNISON PIN
311413469030OtherOHCARESOURCE PIN
BU0499444OtherMEDICARE PTAN
0197989OtherOHUHC PIN
0437021MedicaidOH

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

LicenseStateTypeSpecialty
35045078OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Muskingum County Past Accepting new patients

Organizations & group practices 1

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": "1134518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219104000000",
    "number": "1639154495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "860 BETHESDA DR",
            "city": "ZANESVILLE",
            "state": "OH",
            "postal_code": "437011800",
            "telephone_number": "740-454-4651",
            "fax_number": "740-454-4653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "167 S MAIN ST",
            "city": "ROSEVILLE",
            "state": "OH",
            "postal_code": "437771284",
            "telephone_number": "740-697-7373",
            "fax_number": "740-697-7683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTTERFIELD",
        "first_name": "JACK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-14",
        "last_updated": "2008-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35045078",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "080002140",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PIN",
            "identifier": "000000019419",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE RAILROAD",
            "identifier": "CA1586",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICAID",
            "identifier": "0989499",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISON PIN",
            "identifier": "000000177535",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARESOURCE PIN",
            "identifier": "311413469030",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "BU0499444",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC PIN",
            "identifier": "0197989",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0437021",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2008; 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.