NPIMap

Organization Active NPI

Eastglen Pediatrics, Inc.

  • Primary Care Clinic/Center
  • Columbus, OH
National Provider Identifier
1659413839
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
35031032 Issued in OH
Legal business name
EASTGLEN PEDIATRICS, INC.
Practice address
6495 E Broad St
Suite a
Columbus, OH 43213-1541
Phone
(614) 866-8077
Fax
(614) 866-9752
NPI assigned
Feb 13, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
L. Robert Polster, M.D.NPI 1841252244
Title
President
Phone
(614) 866-8077

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 35031032 OH Primary

Addresses

Primary practice location

6495 E Broad St
Suite a
Columbus, OH 43213-1541

Mailing address

6495 E Broad St
Suite a
Columbus, OH 43213-1541
Phone (614) 866-8077

Other identifiers 1

IdentifierTypeStateIssuer
0222244MedicaidOH

National Provider Directory

National Provider Directory

Locations

6495 E Broad St
Ste A
Columbus, OH 43213
Phone (614) 866-8077

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1659413839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6495 E BROAD ST",
            "address_2": "SUITE A",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432131541",
            "telephone_number": "614-866-8077",
            "fax_number": "614-866-9752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6495 E BROAD ST",
            "address_2": "SUITE A",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432131541",
            "telephone_number": "614-866-8077",
            "fax_number": "614-866-9752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTGLEN PEDIATRICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "POLSTER",
        "authorized_official_first_name": "L.",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "614-866-8077",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "OH",
            "license": "35031032",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0222244",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.