Active NPI
Bob Paul Erdelyi, MD
- Internal Medicine Physician
- Marietta, OH
National Provider Identifier
1780689109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 35075919
- Practice address
- 400 Matthew St
Ste 211
Marietta, OH 45750-1656 - Phone
- (740) 373-6725
- Fax
- (740) 374-4922
- NPI assigned
- Jun 14, 2005
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 35075919 | OH | Primary |
Addresses
Primary practice location
400 Matthew St
Ste 211
Marietta, OH 45750-1656
Mailing address
PO Box 449
Marietta, OH 45750-0449
Phone (740) 374-4500
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000699799 | Other | OH | ANTHEM |
| 110194369 | Other | OH | RRMCR |
| 6000973000 | Medicaid | WV | |
| 000000120129 | Other | OH | ANTHEM |
| 2168685 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190320002775 | OH | Order and Referring Only - Internal Medicine | 0244305472 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35075919 | OH | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313539200000",
"number": "1780689109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 449",
"city": "MARIETTA",
"state": "OH",
"postal_code": "457500449",
"telephone_number": "740-374-4500",
"fax_number": "740-374-5887"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 MATTHEW ST",
"address_2": "STE 211",
"city": "MARIETTA",
"state": "OH",
"postal_code": "457501656",
"telephone_number": "740-373-6725",
"fax_number": "740-374-4922"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ERDELYI",
"first_name": "BOB",
"middle_name": "PAUL",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-14",
"last_updated": "2011-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "OH",
"license": "35075919",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000699799",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RRMCR",
"identifier": "110194369",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6000973000",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000120129",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2168685",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marietta, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.