Active NPI
Joseph Conrad Lawlor, DO
- Family Medicine Physician
- Beavercreek, OH
National Provider Identifier
1801883012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 34.004775
- Practice address
- 3371 Kemp Rd
Beavercreek, OH 45431 - Phone
- (937) 458-4200
- Fax
- (937) 458-4209
- NPI assigned
- Oct 3, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 34.004775 | OH | Primary |
Addresses
Primary practice location
3371 Kemp Rd
Beavercreek, OH 45431
Mailing address
3371 Kemp Rd
Beavercreek, OH 45431-2514
Phone (937) 458-4200
Other practice location 1
859 N Main St
Malta, OH 43758-9007
Phone (740) 962-6111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0757202 | Medicaid | OH |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jlawlor641604@direct.ketteringhealth.org | ||
| FHIR URL | https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/ |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110317000950 | OH | Practitioner - Family Practice | 5496938144 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34.004775 | OH | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611014400000",
"number": "1801883012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3371 KEMP RD",
"city": "BEAVERCREEK",
"state": "OH",
"postal_code": "454312514",
"telephone_number": "937-458-4200",
"fax_number": "937-458-4209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3371 KEMP RD",
"city": "BEAVERCREEK",
"state": "OH",
"postal_code": "45431",
"telephone_number": "937-458-4200",
"fax_number": "937-458-4209"
}
],
"practiceLocations": [
{
"address_1": "859 N Main St",
"address_purpose": "LOCATION",
"city": "Malta",
"state": "OH",
"postal_code": "437589007",
"country_code": "US",
"telephone_number": "740-962-6111",
"fax_number": "740-962-2182",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LAWLOR",
"first_name": "JOSEPH",
"middle_name": "CONRAD",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-03",
"last_updated": "2021-01-19",
"certification_date": "2021-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OH",
"license": "34.004775",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0757202",
"state": "OH"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "jlawlor641604@direct.ketteringhealth.org",
"affiliation": "N",
"address_1": "3371 Kemp Rd",
"city": "Beavercreek",
"state": "OH",
"country_code": "US",
"postal_code": "45431",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/",
"affiliation": "N",
"address_1": "3371 Kemp Rd",
"city": "Beavercreek",
"state": "OH",
"country_code": "US",
"postal_code": "45431",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Beavercreek, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.