Individual provider Active NPI

Bryn Thatcher, MD

  • Student in an Organized Health Care Education/Training Program
  • Dayton, OH
National Provider Identifier
1700397825
Registry record updated Jul 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
57.259516 Issued in OH
Practice address
1 Wyoming St
Dayton, OH 45409-2722
Phone
(937) 208-3882
NPI assigned
Oct 16, 2017
Last updated
Jul 30, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X C.1300114 OH
Student in an Organized Health Care Education/Training Program 390200000X 57.259516 OH Primary
Family Medicine Physician 207Q00000X 11022510A IN
Addiction Medicine (Family Medicine) Physician 207QA0401X 57.259516 OH

Addresses

Primary practice location

1 Wyoming St
Dayton, OH 45409-2722

Mailing address

1 Wyoming St.
Attn: Pam Shank
Dayton, OH 45409
Phone (937) 208-3882

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20220714001953 IN Order and Referring Only - Addiction MedicinePractitioner - Family PracticePractitioner - Addiction Medicine 7214318799

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C.1300114OHMDMental Health Counselor
57.259516OHMDStudent in an Organized Health Care Education/Training Program

NPI Registry JSON

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

{
    "created_epoch": "1508112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753833600000",
    "number": "1700397825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 WYOMING ST.",
            "address_2": "ATTN: PAM SHANK",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "45409",
            "telephone_number": "937-208-3882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WYOMING ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454092722",
            "telephone_number": "937-208-3882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THATCHER",
        "first_name": "BRYN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-16",
        "last_updated": "2025-07-30",
        "certification_date": "2025-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "C.1300114",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": "57.259516",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "11022510A",
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "OH",
            "license": "57.259516",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.