NPIMap

Organization Active NPI

Alliance Physicians Inc

Doing business as Kettering Behavioral Medicine Center

  • Psychiatry Physician
  • Moraine, OH
National Provider Identifier
1780852228
Registry record updated Nov 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
ALLIANCE PHYSICIANS INC
Doing business as
Kettering Behavioral Medicine Center
Practice address
5350 Lamme Rd
Moraine, OH 45439-3215
Phone
(937) 534-4632
Fax
(937) 534-4609
NPI assigned
Feb 19, 2008
Last updated
Nov 16, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
ALLIANCE PHYSICIANS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 16, 2015

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

Authorized official

Name
Mr. Timothy Y Ko
Title
Cfo
Phone
(937) 558-3223

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pastoral Counselor 101YP1600X
Professional Counselor 101YP2500X
Psychiatry Physician 2084P0800X Primary
Child & Adolescent Psychiatry Physician 2084P0804X

Addresses

Primary practice location

5350 Lamme Rd
Moraine, OH 45439-3215

Mailing address

1 Prestige Place
Suite 550
Miamisburg, OH 45342-6115
Phone (937) 762-1300

Other identifiers 1

IdentifierTypeStateIssuer
2379313MedicaidOH

Other names 1

  • Kettering Behavioral Medicine Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031118000529 OH Part B Supplier - Clinic/Group Practice 0840104360 Receives reassigned benefits from 528 practitioners
25 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 25

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 25

National Provider Directory

National Provider Directory
Part of
Northeast Family Practi

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1203379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447632000000",
    "number": "1780852228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PRESTIGE PLACE",
            "address_2": "SUITE 550",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453426115",
            "telephone_number": "937-762-1300",
            "fax_number": "937-522-8493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5350 LAMME RD",
            "city": "MORAINE",
            "state": "OH",
            "postal_code": "454393215",
            "telephone_number": "937-534-4632",
            "fax_number": "937-534-4609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIANCE PHYSICIANS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALLIANCE PHYSICIANS INC",
        "enumeration_date": "2008-02-19",
        "last_updated": "2015-11-16",
        "status": "A",
        "authorized_official_last_name": "KO",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "937-558-3223",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YP1600X",
            "taxonomy_group": "",
            "desc": "Counselor, Pastoral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2379313",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kettering Behavioral Medicine Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moraine, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.