Organization Active NPI

Fleagle Internal Medicine LLC

  • Internal Medicine Physician
  • Dayton, OH
National Provider Identifier
1699967513
Registry record updated May 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
FLEAGLE INTERNAL MEDICINE LLC
Doing business as
KURT FLEAGLE M.D.
Practice address
5250 Far Hills Ave
Suite 210
Dayton, OH 45429
Phone
(937) 434-4775
Fax
(833) 450-5129
NPI assigned
Aug 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2024

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

Authorized official

Name
Dr. Kurt Andrew Fleagle, MDNPI 1750382602
Title
Physician
Phone
(937) 434-4775

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X OH Primary

Addresses

Primary practice location

5250 Far Hills Ave
Suite 210
Dayton, OH 45429

Mailing address

5250 Far Hills Ave
Suite 210
Dayton, OH 45429
Phone (937) 434-4775

Other names 1

  • KURT FLEAGLE M.D. Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041220000710 OH Part B Supplier - Clinic/Group Practice 3173581360 Receives reassigned benefits from 1 practitioner
Practice locations: Dayton, OH

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D1034512Fleagle Internal Medicine LLC5250 Far Hills Ave Suite 210, Dayton, OH 45429Certificate of waiverDec 5, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1187049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714867200000",
    "number": "1699967513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5250 FAR HILLS AVE",
            "address_2": "SUITE 210",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "45429",
            "telephone_number": "937-434-4775",
            "fax_number": "937-434-4779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5250 FAR HILLS AVE",
            "address_2": "SUITE 210",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "45429",
            "telephone_number": "937-434-4775",
            "fax_number": "833-450-5129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLEAGLE INTERNAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-14",
        "last_updated": "2024-05-05",
        "certification_date": "2024-05-05",
        "status": "A",
        "authorized_official_last_name": "FLEAGLE",
        "authorized_official_first_name": "KURT",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "937-434-4775",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KURT FLEAGLE M.D.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dayton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.