Individual provider Active NPI

Stanley Titang Tibong, DNP

  • Nurse Practitioner
  • Dayton, OH
National Provider Identifier
1871825497
Registry record updated Oct 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APRN.CNP.15133 Issued in OH
Practice address
30 E Apple St Ste 5254a
Dayton, OH 45409-2939
Phone
(937) 208-4200
NPI assigned
Feb 6, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN. 344514 OH
Nurse Practitioner 363L00000X APRN.CNP.15133 OH Primary

Addresses

Primary practice location

30 E Apple St Ste 5254a
Dayton, OH 45409-2939

Mailing address

6626 Woodland Trace CT
Liberty TWP, OH 45044-9172
Phone (513) 382-4927

Other identifiers 1

IdentifierTypeStateIssuer
0094838MedicaidOH

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131218000706 OH Practitioner - Nurse Practitioner 3274760210 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Kentucky College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Premier Health Specialists IncGroup PAC ID 5597708594, 576 clinicians

Practice addresses (Care Compare)

1 Medical Ctr Dr
Middletown, OH 45005-2584
Phone (513) 974-2111

1 Wyoming St
Berry Women's Center Labor and Delivery
Dayton, OH 45409-2939
Phone (937) 439-4381

2400 Miami Valley Dr
Centerville, OH 45459-4774

30 E Apple St
Dayton, OH 45409-2939

450 N Hyatt St
Suite 304
Tipp City, OH 45371-1433
Phone (937) 832-4773

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.38 of 100Reported as group
Quality
66.25
Promoting interoperability
100
Improvement activities
40
Cost
71.69

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN. 344514OHMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Magnet Care Home Health LLC CurrentSince Apr 1, 2020 Accepting new patients
Premier Health Specialists Inc Nurse Practitioner CurrentSince Nov 6, 2013 Accepting new patients
Premier Health Specialists Inc CurrentSince Nov 6, 2013 Accepting new patients
Premier Heart Associates, Inc Past Accepting new patients

Locations

30 E Apple St
#6258
Dayton, OH 45409
Phone (937) 208-5300

30 E Apple St
Ste 5254A
Dayton, OH 45409

1049 Summit Dr
Middletown, OH 45042
Phone (513) 423-1399

450 N Hyatt St
Ste 304
Tipp City, OH 45371
Phone (937) 832-4773

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1265414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477612800000",
    "number": "1871825497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6626 WOODLAND TRACE CT",
            "city": "LIBERTY TWP",
            "state": "OH",
            "postal_code": "450449172",
            "telephone_number": "513-382-4927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 E APPLE ST STE 5254A",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454092939",
            "telephone_number": "937-208-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIBONG",
        "first_name": "STANLEY",
        "middle_name": "TITANG",
        "name_prefix": "Dr.",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-02-06",
        "last_updated": "2016-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN. 344514",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "APRN.CNP.15133",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0094838",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.