Individual provider Active NPI

Terry L Irwin, M.D.

  • Internal Medicine Physician
  • Columbus, OH
National Provider Identifier
1699866160
Registry record updated Jul 12, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35-036172 Issued in OH
Practice address
4830 Knightsbridge Blvd
Suite a
Columbus, OH 43214-2300
Phone
(614) 451-2174
Fax
(614) 451-1742
NPI assigned
Sep 27, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 12, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35-036172 OH Primary

Addresses

Primary practice location

4830 Knightsbridge Blvd
Suite a
Columbus, OH 43214-2300

Mailing address

4830 Knightsbridge Blvd
Suite a
Columbus, OH 43214-2300
Phone (614) 451-2174

Other identifiers 1

IdentifierTypeStateIssuer
0293909MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100824001148 OH Practitioner - Internal Medicine 4789657149 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35-036172OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lima Memorial Joint Operating Company Past Accepting new patients

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Willow Brook Christian HomeColumbus, OH, CCN 365988 Skilled nursing facility Corporate Director Jan 1, 2005
Cherith Care Center at Willow BrookDelaware, OH, CCN 366246 Skilled nursing facility Corporate Director
Managing Control - Governing Body
Jan 1, 2005
Jan 1, 2005

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

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": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184198400000",
    "number": "1699866160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4830 KNIGHTSBRIDGE BLVD",
            "address_2": "SUITE A",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432142300",
            "telephone_number": "614-451-2174",
            "fax_number": "614-451-1742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4830 KNIGHTSBRIDGE BLVD",
            "address_2": "SUITE A",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432142300",
            "telephone_number": "614-451-2174",
            "fax_number": "614-451-1742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IRWIN",
        "first_name": "TERRY",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2007-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35-036172",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0293909",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.