Active NPI
Theodore Gullatt III, M.D.
- Family Medicine Physician
- Cincinnati, OH
National Provider Identifier
1740475607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 057470
- Practice address
- 411 Oak St
Sterling Medical Associates
Cincinnati, OH 45219-2504 - Phone
- (513) 984-1800
- Fax
- (513) 984-4909
- NPI assigned
- Sep 12, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 057470 | GA | Primary |
Addresses
Primary practice location
411 Oak St
Sterling Medical Associates
Cincinnati, OH 45219-2504
Mailing address
411 Oak St
Attn: Credentials
Cincinnati, OH 45219-2504
Phone (843) 873-6445
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 057470 | GA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sterling Adult Day Services | Past | Accepting new patients | |
| Sterling Medical Associates | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Military/U.S. Coast Guard Outpatient Clinic/Center
- Cincinnati, OH
- NPI 1336226729
-
- Adult Day Care Clinic/Center
- Colorado Springs, CO
- NPI 1497927529
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189555200000",
"number": "1740475607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "411 OAK ST",
"address_2": "ATTN: CREDENTIALS",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452192504",
"telephone_number": "843-873-6445"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "411 OAK ST",
"address_2": "STERLING MEDICAL ASSOCIATES",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452192504",
"telephone_number": "513-984-1800",
"fax_number": "513-984-4909"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GULLATT",
"first_name": "THEODORE",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-09-12",
"last_updated": "2007-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "GA",
"license": "057470",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cincinnati, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.