Internal Medicine Associates, Inc.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

INTERNAL MEDICINE ASSOCIATES, INC.

Doing business as

Sycamore Wound Center

Practice address

4000 Miamisburg Centerville Rd
Miamisburg, OH 45342-7615

Phone

(937) 384-4329

Fax

(937) 384-4853

NPI assigned

Apr 17, 2008

Last updated

Oct 30, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Daniel D Haibach

Title

Director of Network Contracting

Phone

(937) 558-3222

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Sycamore Wound Center Doing business as

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

{
    "created_epoch": "1208390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351555200000",
    "number": "1861666141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2110 LEITER RD",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453423598",
            "telephone_number": "937-384-4838",
            "fax_number": "937-384-4845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 MIAMISBURG CENTERVILLE RD",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453427615",
            "telephone_number": "937-384-4329",
            "fax_number": "937-384-4853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-17",
        "last_updated": "2012-10-30",
        "status": "A",
        "authorized_official_last_name": "HAIBACH",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIRECTOR OF NETWORK CONTRACTING",
        "authorized_official_telephone_number": "937-558-3222",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0559435",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2461429",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2963164",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2884142",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0707882",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sycamore Wound Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Danna Isaacs
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• Miranda Ismail, RBT
• Amanda Nicole Jackson, LPN
• Bryan John Jacobs, M.D.

• Clinic/Center in Miamisburg, OH
• Providers in Miamisburg, OH by specialty
• Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2012; 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.