Active NPI
Providence Medical Group
- Podiatrist
- Moraine, OH
National Provider Identifier
1811304595
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 36.003657
- Legal business name
- PROVIDENCE MEDICAL GROUP
- Practice address
- 2912 Springboro Rd
Suite 201
Moraine, OH 45439-1674 - Phone
- (937) 297-8999
- Fax
- (937) 297-4852
- NPI assigned
- Jul 15, 2014
- Organization subpart
- Yes
- Parent organization
- PROVIDENCE PODIATRY
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Susan Becker, COO
- Title
- Chief Operating Officer
- Phone
- (937) 297-8999
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 36.003657 | OH | Primary |
Addresses
Primary practice location
2912 Springboro Rd
Suite 201
Moraine, OH 45439-1674
Mailing address
2912 Springboro Rd
Suite 201
Moraine, OH 45439-1674
Phone (937) 297-8999
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285952937 | Other | OH | INDIVIDUAL NPI |
| 2380294 | Medicaid | OH | |
| 0083030 | Medicaid | OH |
National Provider Directory
National Provider Directory- Part of
- Providence Medical Group Inc
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pediatrics Physician
- Centerville, OH
- NPI 1679666085
-
- Family Nurse Practitioner
- Moraine, OH
- NPI 1972886943
-
- General Practice Physician
- Moraine, OH
- NPI 1699831693
-
- Family Nurse Practitioner
- Waynesville, OH
- NPI 1578010740
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405382400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1414454400000",
"number": "1811304595",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2912 SPRINGBORO RD",
"address_2": "SUITE 201",
"city": "MORAINE",
"state": "OH",
"postal_code": "454391674",
"telephone_number": "937-297-8999",
"fax_number": "937-297-4852"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2912 SPRINGBORO RD",
"address_2": "SUITE 201",
"city": "MORAINE",
"state": "OH",
"postal_code": "454391674",
"telephone_number": "937-297-8999",
"fax_number": "937-297-4852"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PROVIDENCE MEDICAL GROUP",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PROVIDENCE PODIATRY",
"enumeration_date": "2014-07-15",
"last_updated": "2014-10-28",
"status": "A",
"authorized_official_last_name": "BECKER",
"authorized_official_first_name": "SUSAN",
"authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
"authorized_official_telephone_number": "937-297-8999",
"authorized_official_credential": "COO"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Podiatrist",
"state": "OH",
"license": "36.003657",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDIVIDUAL NPI",
"identifier": "1285952937",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2380294",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0083030",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Moraine, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.