NPIMap

Organization Active NPI

Pain Evaluation & Management Center of Ohio, Inc.

  • Pain Medicine Physician
  • Centerville, OH
National Provider Identifier
1811940182
Registry record updated Jan 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
Legal business name
PAIN EVALUATION & MANAGEMENT CENTER OF OHIO, INC.
Practice address
1550 Yankee Park PL
Ste a
Centerville, OH 45458-1838
Phone
(937) 439-4949
Fax
(937) 439-4948
NPI assigned
May 18, 2006
Last updated
Jan 15, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2013

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

Authorized official

Name
Dr. Richard Martin Donnini, D.O.NPI 1316912413
Title
Co-Owner
Phone
(937) 439-4949

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NU
Family Medicine Physician 207Q00000X NU
Pain Medicine Physician 208VP0000X NU Primary
Physical Therapist 225100000X NU

Addresses

Primary practice location

1550 Yankee Park PL
Ste a
Centerville, OH 45458-1838

Mailing address

Dept L-2433
Columbus, OH 43260-0001
Phone (937) 439-4949

Other identifiers 1

IdentifierTypeStateIssuer
0236104MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050918000012 OH Part B Supplier - Clinic/Group Practice 2365475480 Receives reassigned benefits from 19 practitioners
Practice locations: Beavercreek, OH; Centerville, OH; Mason, OH
O20100930021996 OH DME Supplier - Multi-Specialty - Physician 2365475480 Practice locations: Centerville, OH

National Provider Directory

National Provider Directory
Tax ID family
Pain Evaluation Manageme3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

1512 Yankee Park Pl
#A
Centerville, OH 45458
Phone (937) 439-4949

Dept L2433
Columbus, OH 43260

1550 Yankee Park Pl
Ste A
Dayton, OH 45458
Phone (937) 439-4949

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358208000000",
    "number": "1811940182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT L-2433",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432600001",
            "telephone_number": "937-439-4949",
            "fax_number": "937-439-4948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 YANKEE PARK PL",
            "address_2": "STE A",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454581838",
            "telephone_number": "937-439-4949",
            "fax_number": "937-439-4948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN EVALUATION & MANAGEMENT CENTER OF OHIO, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2013-01-15",
        "status": "A",
        "authorized_official_last_name": "DONNINI",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "MARTIN",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "937-439-4949",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0236104",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Centerville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.