Jack R. Pence II, MD

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

35043064P Issued in OH

Practice address

1911 N Fairfield Rd
Suite 300
Beavercreek, OH 45432-2762

Phone

(937) 429-7352

Fax

(937) 429-3772

NPI assigned

Jul 8, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Dayton Physicians, LLC

  • Durable Medical Equipment & Medical Supplies
  • Dayton, OH
  • NPI 1811141559

  Urology

  NPD (past)
• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)
• Urology Associates of Dayton, Inc.

  • Urology Physician
  • Dayton, OH
  • NPI 1043318801
  NPD (past)

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395014400000",
    "number": "1851399414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6680 POE AVE",
            "address_2": "SUITE 200",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454142854",
            "telephone_number": "937-280-8366",
            "fax_number": "937-280-8373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1911 N FAIRFIELD RD",
            "address_2": "SUITE 300",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454322762",
            "telephone_number": "937-429-7352",
            "fax_number": "937-429-3772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENCE",
        "first_name": "JACK",
        "middle_name": "R.",
        "name_suffix": "II",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-08",
        "last_updated": "2014-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "OH",
            "license": "35-043064",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "OH",
            "license": "35043064",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "OH",
            "license": "35043064P",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0622857",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ajai Paul
• Heather R Pavy
• Tyler Matthew Peckham
• Pediatric Associates of Dayton, Inc.
• Courtney Pemberton, APRN
• Natalie Pennyman, MSW,LISW-S
• Maureen Kennedy Perez, MD
• Marcia Perio-Epps
• Erin Leigh Perkey Nienaber, DO
• Philip Stephen Perona, MD

• Urology Physician in Beavercreek, OH
• Providers in Beavercreek, OH by specialty
• Urology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.

Verify at the official NPI Registry.