NPIMap

Organization Active NPI

Premier Heart Associates, Inc

  • Cardiovascular Disease Physician
  • Dayton, OH
National Provider Identifier
1881690964
Registry record updated Oct 12, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
PREMIER HEART ASSOCIATES, INC
Practice address
9000 N Main St
Ste 101
Dayton, OH 45415-1184
Phone
(937) 832-2425
Fax
(937) 832-9804
NPI assigned
Jun 23, 2005
Last updated
Oct 12, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2007

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

Authorized official

Name
George T Broderick X, MDNPI 1134125271
Title
President
Phone
(937) 832-2425

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X Primary

Addresses

Primary practice location

9000 N Main St
Ste 101
Dayton, OH 45415-1184

Mailing address

9000 N Main St
Ste 101
Dayton, OH 45415-1184
Phone (937) 832-2425

Other identifiers 1

IdentifierTypeStateIssuer
2212117MedicaidOH

National Provider Directory

National Provider Directory

Locations

9000 N Main St
Ste 302
Englewood, OH 45415

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192147200000",
    "number": "1881690964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 N MAIN ST",
            "address_2": "STE 101",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454151184",
            "telephone_number": "937-832-2425",
            "fax_number": "937-832-9804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 N MAIN ST",
            "address_2": "STE 101",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454151184",
            "telephone_number": "937-832-2425",
            "fax_number": "937-832-9804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER HEART ASSOCIATES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-23",
        "last_updated": "2007-10-12",
        "status": "A",
        "authorized_official_last_name": "BRODERICK",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "937-832-2425",
        "authorized_official_name_suffix": "X",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2212117",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2007; 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.