NPIMap

Individual provider Active NPI

Mimi T Van, DO

  • Gastroenterology Physician
  • West Chester, OH
National Provider Identifier
1801298294
Registry record updated Dec 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
34.017575 Issued in OH
Practice address
7675 Wellness Way
West Chester, OH 45069-2509
Phone
(513) 475-7505
Fax
(513) 475-8898
NPI assigned
Sep 17, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 9, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OS13825 FL
Gastroenterology Physician 207RG0100X 7793 AZ
Gastroenterology Physician 207RG0100X DO2023-1014 NM
Gastroenterology Physician 207RG0100X 34.017575 OH Primary

Addresses

Primary practice location

7675 Wellness Way
West Chester, OH 45069-2509

Mailing address

PO Box 636256
Cincinnati, OH 45263-6256
Phone (513) 585-6200

Other practice location 1

4705 Montgomery Blvd NE Ste 201
Albuquerque, NM 87109-1233
Phone (505) 727-7833

Other practice location 2

5555 E Baseline Rd
Mesa, AZ 85206-4709
Phone (480) 393-0575

Other practice location 3

1390 W 16th St
Yuma, AZ 85364-4430
Phone (928) 344-4325

Other practice location 4

201 14th St SW
Gme
Largo, FL 33770-3133
Phone (727) 588-5200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, OH2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200513001155 AZ Practitioner - Gastroenterology 0244528024 Reassigns benefits to 1 organization
I20241216003729 OH Practitioner - Gastroenterology 0244528024 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Midwestern University, Chicago College of Osteopathic Med, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
VHS Outpatient Clinics IncGroup PAC ID 4486566726, 206 clinicians

Practice addresses (Care Compare)

9321 W Thomas Rd
Suite 405
Phoenix, AZ 85037-3399
Phone (623) 236-8507

Hospital & facility affiliations

  • Valleywise Health Medical Center Hospital, Phoenix, AZ, CCN 030022

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy15
Upper gastrointestinal (GI) endoscopy for acid reflux19

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7793AZMDGastroenterology Physician
DO2023-1014NMMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Cincinnati Physicians Company, LLC Family Medicine CurrentSince Jan 1, 2025 Accepting new patients
Yuma Regional Medical Center CurrentSince Sep 30, 2024 Accepting new patients
Reddy Gi Associates CurrentSince Jan 10, 2021 Accepting new patients
District Medical Group, Inc CurrentSince Mar 10, 2024 Accepting new patients
District Medical Group, Inc Gastroenterology CurrentSince Mar 10, 2024 Accepting new patients
District Medical Group, Inc Current Accepting new patients
University of Cincinnati Medical Center, LLC Current Accepting new patients
District Medical Group, Inc Family Medicine Past Accepting new patients
Clinical Associates in Internal Medicine, LTD Past Accepting new patients
Central Arizona Gi & Liver Institute LLC Past Accepting new patients

Locations

5555 E Baseline Rd
Mesa, AZ 85206
Phone (480) 393-5075

8088 W Whitney Dr
Peoria, AZ 85345
Phone (602) 655-2000

2525 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 344-1015

3141 N 3rd Ave
Phoenix, AZ 85013
Phone (602) 914-1520

2929 E Thomas Rd
Phoenix, AZ 85016
Phone (602) 470-5043

2601 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 220-0298

2400 S Avenue A
Yuma, AZ 85364
Phone (928) 336-7100

1390 W 16th St
Yuma, AZ 85364
Phone (928) 344-4325

3188 Bellevue Ave
Cincinnati, OH 45219
Phone (513) 558-5281

2123 Auburn Ave
#A28
Cincinnati, OH 45219
Phone (513) 585-0523

3200 Burnet Ave
#2
Cincinnati, OH 45229
Phone (513) 585-5505

7675 Wellness Way
West Chester, OH 45069
Phone (513) 475-7400

7700 University Dr
West Chester, OH 45069
Phone (513) 298-3000

Interoperability endpoints

  • Direct secure messaging: mvan215232@direct.valleywisehealth.org

Organizations & group practices 11

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 12

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": "1410912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733702400000",
    "number": "1801298294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 636256",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452636256",
            "telephone_number": "513-585-6200",
            "fax_number": "513-245-3672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7675 WELLNESS WAY",
            "city": "WEST CHESTER",
            "state": "OH",
            "postal_code": "450692509",
            "telephone_number": "513-475-7505",
            "fax_number": "513-475-8898"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4705 Montgomery Blvd NE Ste 201",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871091233",
            "country_code": "US",
            "telephone_number": "505-727-7833",
            "fax_number": "505-727-9590",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5555 E Baseline Rd",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852064709",
            "country_code": "US",
            "telephone_number": "480-393-0575",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1390 W 16th St",
            "address_purpose": "LOCATION",
            "city": "Yuma",
            "state": "AZ",
            "postal_code": "853644430",
            "country_code": "US",
            "telephone_number": "928-344-4325",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "201 14th St SW",
            "address_2": "GME",
            "address_purpose": "LOCATION",
            "city": "Largo",
            "state": "FL",
            "postal_code": "337703133",
            "country_code": "US",
            "telephone_number": "727-588-5200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAN",
        "first_name": "MIMI",
        "middle_name": "T",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-09-17",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "OS13825",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "AZ",
            "license": "7793",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NM",
            "license": "DO2023-1014",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "OH",
            "license": "34.017575",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Chester, OH

Sources for this page

Verify at the official NPI Registry.