Active NPI
Samaritan Family Care Inc
- Family Medicine Physician
- Vandalia, OH
National Provider Identifier
1720161086
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- SAMARITAN FAMILY CARE INC
- Practice address
- 810 Falls Creek Dr
Suite B
Vandalia, OH 45377-8600 - Phone
- (937) 454-0317
- Fax
- (937) 454-1668
- NPI assigned
- Oct 23, 2006
- Organization subpart
- Yes
- Parent organization
- SAMARITAN FAMILY CARE INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kenneth Prunier
- Title
- Ceo/Presiden
- Phone
- (937) 208-8273
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
810 Falls Creek Dr
Suite B
Vandalia, OH 45377-8600
Mailing address
810 Falls Creek Dr
Suite B
Vandalia, OH 45377-8600
Phone (937) 454-0317
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2552134 | Medicaid | OH |
Other names 1
- Family Medicine of Vandalia
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040203000210 | OH | Part B Supplier - Clinic/Group Practice | 5092608372 |
Receives reassigned benefits from 160 practitioners 19 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Englewood, OH; Vandalia, OH; New Lebanon, OH; Lewisburg, OH; Huber Heights, OH; Dayton, OH; Brookville, OH |
Other NPIs on the same Medicare enrollment 19
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Family Medicine Physician
- Huber Heights, OH
- NPI 1467407544
O20040203000210
-
- Family Medicine Physician
- Huber Heights, OH
- NPI 1740516046
O20040203000210
National Provider Directory
National Provider Directory- Part of
- Samaritan Pediatrics SF
Practitioners & affiliated clinicians
Practitioners 2
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": "1161561600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1383868800000",
"number": "1720161086",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "810 FALLS CREEK DR",
"address_2": "SUITE B",
"city": "VANDALIA",
"state": "OH",
"postal_code": "453778600",
"telephone_number": "937-454-0317",
"fax_number": "937-454-1668"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "810 FALLS CREEK DR",
"address_2": "SUITE B",
"city": "VANDALIA",
"state": "OH",
"postal_code": "453778600",
"telephone_number": "937-454-0317",
"fax_number": "937-454-1668"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SAMARITAN FAMILY CARE INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "SAMARITAN FAMILY CARE INC",
"enumeration_date": "2006-10-23",
"last_updated": "2013-11-08",
"status": "A",
"authorized_official_last_name": "PRUNIER",
"authorized_official_first_name": "KENNETH",
"authorized_official_title_or_position": "CEO/PRESIDEN",
"authorized_official_telephone_number": "937-208-8273"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2552134",
"state": "OH"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Family Medicine of Vandalia",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Vandalia, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2013; 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.