NPIMap

Organization Active NPI

Samaritan Family Care Inc

Doing business as Lewisburg Family Practice

  • Family Medicine Physician
  • Lewisburg, OH
National Provider Identifier
1730454281
Registry record updated Nov 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SAMARITAN FAMILY CARE INC
Doing business as
Lewisburg Family Practice
Practice address
500 N Main St
Lewisburg, OH 45338-9503
Phone
(937) 962-2618
Fax
(937) 962-4971
NPI assigned
Mar 16, 2012
Last updated
Nov 8, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
SAMARITAN FAMILY CARE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 8, 2013

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

Authorized official

Name
Kenneth Prunier
Title
President/Ceo
Phone
(937) 208-8213

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

500 N Main St
Lewisburg, OH 45338-9503

Mailing address

500 N Main St
Lewisburg, OH 45338-9503
Phone (937) 962-2618

Other identifiers 1

IdentifierTypeStateIssuer
0062709MedicaidOH

Other names 1

  • Lewisburg Family Practice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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.

View all 19

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
36D0897576Lewisburg Family Practice Inc500 North Main Street, Lewisburg, OH 45338Certificate of waiverApr 30, 2027

National Provider Directory

National Provider Directory
Part of
Samaritian Family Care

NPI Registry JSON

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

{
    "created_epoch": "1331856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383868800000",
    "number": "1730454281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 N MAIN ST",
            "city": "LEWISBURG",
            "state": "OH",
            "postal_code": "453389503",
            "telephone_number": "937-962-2618",
            "fax_number": "937-962-4971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N MAIN ST",
            "city": "LEWISBURG",
            "state": "OH",
            "postal_code": "453389503",
            "telephone_number": "937-962-2618",
            "fax_number": "937-962-4971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMARITAN FAMILY CARE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAMARITAN FAMILY CARE INC",
        "enumeration_date": "2012-03-16",
        "last_updated": "2013-11-08",
        "status": "A",
        "authorized_official_last_name": "PRUNIER",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "937-208-8213"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0062709",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lewisburg Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lewisburg, 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.
  • 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.