NPIMap

Organization Active NPI

Upper Valley Professional Corporation

  • Pediatrics Physician
  • Tipp City, OH
National Provider Identifier
1720170038
Registry record updated Aug 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
UPPER VALLEY PROFESSIONAL CORPORATION
Practice address
450 N Hyatt St
Suite 306
Tipp City, OH 45371-1433
Phone
(937) 440-8687
Fax
(937) 773-8058
NPI assigned
Sep 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2010

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

Authorized official

Name
Pamela Rader
Title
Administrator
Phone
(937) 440-7454

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X OH Primary

Addresses

Primary practice location

450 N Hyatt St
Suite 306
Tipp City, OH 45371-1433

Mailing address

PO Box 479
Troy, OH 45373-0479
Phone (937) 440-8687

Other identifiers 1

IdentifierTypeStateIssuer
2616404MedicaidOH

Other names 1

  • Pediatric Group Doing business as

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
36D1020341Uvpc the Pediatric Group450 N Hyatt St Ste 204, Tipp City, OH 45371Certificate of waiverDec 16, 2027

National Provider Directory

National Provider Directory
Tax ID family
Upper Valley Prof Corp9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282262400000",
    "number": "1720170038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 479",
            "city": "TROY",
            "state": "OH",
            "postal_code": "453730479",
            "telephone_number": "937-440-8687",
            "fax_number": "937-773-8058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 N HYATT ST",
            "address_2": "SUITE 306",
            "city": "TIPP CITY",
            "state": "OH",
            "postal_code": "453711433",
            "telephone_number": "937-440-8687",
            "fax_number": "937-773-8058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPPER VALLEY PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2010-08-20",
        "status": "A",
        "authorized_official_last_name": "RADER",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "937-440-7454"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2616404",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tipp City, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.