NPIMap

Organization Active NPI

Samaritan Family Care Inc

Doing business as Family Medicine of Huber Heights

  • Family Medicine Physician
  • Huber Heights, OH
National Provider Identifier
1740516046
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
Family Medicine of Huber Heights
Practice address
8638 Old Troy Pike
Suite 103
Huber Heights, OH 45424-1051
Phone
(937) 237-9575
NPI assigned
Oct 22, 2009
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 Primary

Addresses

Primary practice location

8638 Old Troy Pike
Suite 103
Huber Heights, OH 45424-1051

Mailing address

8638 Old Troy Pike
Suite 103
Huber Heights, OH 45424-1051
Phone (937) 237-9575

Other identifiers 1

IdentifierTypeStateIssuer
3011092MedicaidOH

Other names 1

  • Family Medicine of Huber Heights 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
36D0719944Family Medicine of Huber Heights8638 Old Troy Pike Suite 103, Huber Heights, OH 45424Certificate of waiverAug 31, 2026
36D2330084Premier Family Medicine Huber Heights8638 Old Troy Pike, Suite a, Huber Heights, OH 45424Provider-performed microscopySep 9, 2027

National Provider Directory

National Provider Directory
Part of
Samaritian Family Care

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1256169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383868800000",
    "number": "1740516046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8638 OLD TROY PIKE",
            "address_2": "SUITE 103",
            "city": "HUBER HEIGHTS",
            "state": "OH",
            "postal_code": "454241051",
            "telephone_number": "937-237-9575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8638 OLD TROY PIKE",
            "address_2": "SUITE 103",
            "city": "HUBER HEIGHTS",
            "state": "OH",
            "postal_code": "454241051",
            "telephone_number": "937-237-9575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMARITAN FAMILY CARE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAMARITAN FAMILY CARE INC",
        "enumeration_date": "2009-10-22",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3011092",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medicine of Huber Heights",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Huber Heights, 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.