NPIMap

Organization Active NPI

Premier Integrated Medical Associates, LTD

  • Pediatrics Physician
  • Englewood, OH
National Provider Identifier
1790749307
Registry record updated Mar 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PREMIER INTEGRATED MEDICAL ASSOCIATES, LTD
Practice address
120 W Wenger Rd
Englewood, OH 45322-2762
Phone
(937) 836-9921
Fax
(937) 836-1298
NPI assigned
Apr 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2016

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

Authorized official

Name
Dr. Gerald A Molfenter, MD
Title
President
Phone
(937) 836-9921

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

120 W Wenger Rd
Englewood, OH 45322-2762

Mailing address

25 Merchant St
Ste. 220
Cincinnati, OH 45246-3700
Phone (513) 533-6507

Other identifiers 1

IdentifierTypeStateIssuer
2080948MedicaidOH

Other names 1

  • PRIMED NORTHWEST DAYTON PEDS Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Premier Integrated Medi7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1144800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457654400000",
    "number": "1790749307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 MERCHANT ST",
            "address_2": "STE. 220",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452463700",
            "telephone_number": "513-533-6507",
            "fax_number": "513-645-9767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 W WENGER RD",
            "city": "ENGLEWOOD",
            "state": "OH",
            "postal_code": "453222762",
            "telephone_number": "937-836-9921",
            "fax_number": "937-836-1298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER INTEGRATED MEDICAL ASSOCIATES, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-12",
        "last_updated": "2016-03-11",
        "status": "A",
        "authorized_official_last_name": "MOLFENTER",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "937-836-9921",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2080948",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PRIMED NORTHWEST DAYTON PEDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Englewood, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.