Individual provider Active NPI

Jenna Pathadan, D.O.

  • Internal Medicine Physician
  • Dayton, OH
National Provider Identifier
1790104362
Registry record updated Dec 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
34013035 Issued in OH
Practice address
128 E Apple St
2ND Floor
Dayton, OH 45409-2902
Phone
(937) 208-2004
Fax
(937) 208-8828
NPI assigned
Apr 10, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X OH
Internal Medicine Physician 207R00000X 34013035 OH Primary

Addresses

Primary practice location

128 E Apple St
2ND Floor
Dayton, OH 45409-2902

Mailing address

128 E Apple St
2ND Floor
Dayton, OH 45409-2902
Phone (937) 208-2004

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180110003326 OH Practitioner - Internal Medicine 4587884853 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Lake Erie College of Osteopathic Medicine, Erie, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Ohio Hospitalists, IncGroup PAC ID 7810985686, 194 clinicians

Practice addresses (Care Compare)

3535 Olentangy River Rd
Columbus, OH 43214-3908
Phone (614) 566-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
34013035OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Ohio Hospitalists, Inc CurrentSince Dec 14, 2017 Accepting new patients
Medone Long-Term Acute Care LLC CurrentSince Mar 1, 2025 Accepting new patients
Ohiohealth Corporation Past Accepting new patients

Locations

2155 Dana Ave
Cincinnati, OH 45207
Phone (513) 601-0600

2139 Auburn Ave
Cincinnati, OH 45219
Phone (513) 585-0406

3535 Olentangy River Rd
Columbus, OH 43214
Phone (614) 566-1997

1430 S High St
Columbus, OH 43207
Phone (614) 255-6930

1087 Dennison Ave
Columbus, OH 43201
Phone (614) 458-9000

Organizations & group practices 3

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1397088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512950400000",
    "number": "1790104362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 E APPLE ST",
            "address_2": "2ND FLOOR",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454092902",
            "telephone_number": "937-208-2004",
            "fax_number": "937-208-8828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 E APPLE ST",
            "address_2": "2ND FLOOR",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454092902",
            "telephone_number": "937-208-2004",
            "fax_number": "937-208-8828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATHADAN",
        "first_name": "JENNA",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-10",
        "last_updated": "2017-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "34013035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.