NPIMap

Organization Active NPI

Mary Rutan Hospital

Doing business as General Surgery

  • Surgery Physician
  • Bellefontaine, OH
National Provider Identifier
1689712879
Registry record updated Dec 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
MARY RUTAN HOSPITAL
Doing business as
General Surgery
Practice address
114 Dowell Ave
Bellefontaine, OH 43311-2305
Phone
(937) 592-1099
NPI assigned
Feb 1, 2007
Last updated
Dec 5, 2007By the provider in NPPES
Organization subpart
Yes
Parent organization
MARY RUTAN HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 5, 2007

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

Authorized official

Name
Ronald Carmin
Title
VP, Fiscal Services
Phone
(937) 592-4015

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU Primary

Addresses

Primary practice location

114 Dowell Ave
Bellefontaine, OH 43311-2305

Mailing address

114 Dowell Ave
Bellefontaine, OH 43311-2305
Phone (937) 592-1099

Other identifiers 1

IdentifierTypeStateIssuer
7607503MedicaidOH

Other names 1

  • General Surgery Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031124000531 OH Part B Supplier - Clinic/Group Practice 9032013792 Receives reassigned benefits from 132 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bellefontaine, OH; Waynesfield, OH; Urbana, OH; Saint Paris, OH; Russells Point, OH; Lima, OH; Lakeview, OH; Kenton, OH…

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Part of
Madriver Family Pract

Locations

114 Dowell Ave
Bellefontaine, OH 43311
Phone (937) 592-1099

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

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": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196812800000",
    "number": "1689712879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 DOWELL AVE",
            "city": "BELLEFONTAINE",
            "state": "OH",
            "postal_code": "433112305",
            "telephone_number": "937-592-1099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 DOWELL AVE",
            "city": "BELLEFONTAINE",
            "state": "OH",
            "postal_code": "433112305",
            "telephone_number": "937-592-1099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY RUTAN HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARY RUTAN HOSPITAL",
        "enumeration_date": "2007-02-01",
        "last_updated": "2007-12-05",
        "status": "A",
        "authorized_official_last_name": "CARMIN",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "VP, FISCAL SERVICES",
        "authorized_official_telephone_number": "937-592-4015"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7607503",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "General Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bellefontaine, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2007; 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.