Individual provider Active NPI

Joseph Conrad Lawlor, DO

  • Family Medicine Physician
  • Beavercreek, OH
National Provider Identifier
1801883012
Registry record updated Jan 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
34.004775 Issued in OH
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

Updated by the provider on Jan 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
0757202MedicaidOH

Electronic endpoints 2

TypeEndpointUseAffiliation
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110317000950 OH Practitioner - Family Practice 5496938144

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34.004775OHMDFamily 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

Verify at the official NPI Registry.