Individual provider Active NPI

Dwayne Timothy Coon, PH.D.

  • Psychologist
  • Columbus, OH
National Provider Identifier
1699963595
Registry record updated Mar 12, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6527 Issued in OH
Practice address
2200 W Broad St
Columbus, OH 43223-1297
Phone
(614) 752-0333
NPI assigned
Oct 5, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 6527 OH Primary

Addresses

Primary practice location

2200 W Broad St
Columbus, OH 43223-1297

Mailing address

2200 W Broad St
Columbus, OH 43223-1297
Phone (614) 752-0333

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071120000013 OH Practitioner - Clinical Psychologist 1052409372 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6527OHMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
State of Ohio Office of Budget and Management State Accounting Current Accepting new patients
State of Ohio Office of Budget and Management State Accounting CurrentSince Feb 13, 2009 Accepting new patients
State of Ohio Office of Budget and Management State Accounting CurrentSince Feb 13, 2009 Accepting new patients

Locations

2200 W Broad St
Columbus, OH 43223

30 E Broad St
Fl 11
Columbus, OH 43215
Phone (614) 466-9930

Organizations & group practices 3

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": "1191542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236816000000",
    "number": "1699963595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 W BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432231297",
            "telephone_number": "614-752-0333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 W BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432231297",
            "telephone_number": "614-752-0333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COON",
        "first_name": "DWAYNE",
        "middle_name": "TIMOTHY",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-05",
        "last_updated": "2009-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OH",
            "license": "6527",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.