NPIMap

Individual provider Active NPI

Troy Michael Puckett, D.O.

  • Family Medicine Physician
  • New Riegel, OH
National Provider Identifier
1881748457
Registry record updated Nov 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
34010646 Issued in OH
Practice address
15 N Perry St
New Riegel, OH 44853-9777
Phone
(567) 281-1024
Fax
(587) 281-1464
NPI assigned
Jan 22, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 34010646 OH Primary

Addresses

Primary practice location

15 N Perry St
New Riegel, OH 44853-9777

Mailing address

15 N Perry St
New Riegel, OH 44853-9777
Phone (567) 281-1024

Other identifiers 1

IdentifierTypeStateIssuer
0071312MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tpuckett805762@direct.mercy.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121008000647 OH Practitioner - Family Practice 5193974103 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Ohio University, College of Osteopathic Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wyandot Memorial HospitalGroup PAC ID 1557340189, 70 clinicians

Practice addresses (Care Compare)

235 E N St
Carey, OH 43351
Phone (419) 396-9201

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
34010646OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wyandot Memorial Hospital CurrentSince Nov 8, 2021 Accepting new patients
Wyandot Memorial Hospital CurrentSince Nov 8, 2021 Accepting new patients
Blanchard Valley Residential Services, Inc. Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Wyandot Memorial Hospital Family Medicine Past Accepting new patients

Locations

235 E North St
Carey, OH 43316
Phone (419) 396-9201

885 N Sandusky Ave
Upper Sandusky, OH 43351
Phone (419) 294-4991

Interoperability endpoints

  • Direct secure messaging: tpuckett96381@direct.bsmhealth.org

Organizations & group practices 5

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.

Hospital & facility affiliations 6

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": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636934400000",
    "number": "1881748457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 N PERRY ST",
            "city": "NEW RIEGEL",
            "state": "OH",
            "postal_code": "448539777",
            "telephone_number": "567-281-1024",
            "fax_number": "567-281-1464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 N PERRY ST",
            "city": "NEW RIEGEL",
            "state": "OH",
            "postal_code": "448539777",
            "telephone_number": "567-281-1024",
            "fax_number": "587-281-1464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCKETT",
        "first_name": "TROY",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2021-11-15",
        "certification_date": "2021-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "34010646",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0071312",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tpuckett805762@direct.mercy.com",
            "affiliation": "N",
            "address_1": "15 N Perry St",
            "city": "New Riegel",
            "state": "OH",
            "country_code": "US",
            "postal_code": "448539777",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in New Riegel, OH

Sources for this page

Verify at the official NPI Registry.