NPIMap

Individual provider Active NPI

Mamle Anim, MD

  • Internal Medicine Physician
  • Dayton, OH
National Provider Identifier
1790741536
Registry record updated Aug 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35371306 Issued in OH
Practice address
721 Miami Chapel Rd
Dayton, OH 45417-4650
Phone
(937) 281-6800
NPI assigned
Apr 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35371306 OH Primary

Addresses

Primary practice location

721 Miami Chapel Rd
Dayton, OH 45417-4650

Mailing address

725 University Blvd
Dayton, OH 45435-0001
Phone (937) 245-7100

Other identifiers 1

IdentifierTypeStateIssuer
2016759MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041019001471 OH Practitioner - Internal Medicine 0547221954 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Five Rivers Health CentersGroup PAC ID 9335300904, 45 clinicians

Practice addresses (Care Compare)

721 Miami Chapel Rd
Dayton, OH 45417-4650
Phone (937) 281-6800

Hospital & facility affiliations

  • Miami Valley Hospital Hospital, Dayton, OH, CCN 360051

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35371306OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Five Rivers Health Centers CurrentSince May 23, 2011 Accepting new patients
Five Rivers Health Centers Current Accepting new patients
Wright State Physicians Inc Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

2261 Philadelphia Dr
Dayton, OH 45406
Phone (937) 281-6800

721 Miami Chapel Rd
Dayton, OH 45417
Phone (937) 281-5970

Ownership & related parties

All facility ownership & control disclosures 7

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Five Rivers Health CentersDayton, OH, CCN 361007 Federally qualified health center Corporate Officer May 23, 2011
Five Rivers Health Centers Samaritan Homeless ClinicDayton, OH, CCN 361076 Federally qualified health center Corporate Officer May 23, 2011
Five Rivers Health CentersXenia, OH, CCN 361134 Federally qualified health center Corporate Officer May 23, 2011
Five Rivers Health Centers Star PediatricsXenia, OH, CCN 721810 Federally qualified health center Corporate Officer May 23, 2011
Five Rivers Health CentersDayton, OH, CCN 721837 Federally qualified health center Corporate Officer May 23, 2011
Five Rivers Health CentersDayton, OH, CCN 721894 Federally qualified health center Corporate Officer May 23, 2011
Five Rivers Health CentersDayton, OH, CCN 721010 Federally qualified health center Corporate Officer May 23, 2011

Owned or controlled facilities with NPI records 7

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 12

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 1

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": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661472000000",
    "number": "1790741536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 UNIVERSITY BLVD",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454350001",
            "telephone_number": "937-245-7100",
            "fax_number": "937-245-7999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 MIAMI CHAPEL RD",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454174650",
            "telephone_number": "937-281-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANIM",
        "first_name": "MAMLE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-21",
        "last_updated": "2022-08-26",
        "certification_date": "2022-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35371306",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2016759",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.