NPIMap

Organization Active NPI

Child and Adolescent Specialty Care of Dayton Inc.

  • Pediatric Adolescent Medicine Physician
  • Tipp City, OH
National Provider Identifier
1881794113
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
Legal business name
CHILD AND ADOLESCENT SPECIALTY CARE OF DAYTON INC.
Practice address
1483 West Main Street
Tipp City, OH 45371
Phone
(937) 667-7711
Fax
(937) 667-8067
NPI assigned
Sep 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mary Ann Galemmo, L.P.N.
Title
Nursing Office Manager
Phone
(937) 667-7711

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080A0000X Primary

Addresses

Primary practice location

1483 West Main Street
Tipp City, OH 45371

Mailing address

1483 West Main Street
Tipp City, OH 45371
Phone (937) 667-7711

Other identifiers 1

IdentifierTypeStateIssuer
0382910MedicaidOH

National Provider Directory

National Provider Directory

Locations

2760 S County Road 25A
Troy, OH 45373
Phone 93764134012

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1881794113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1483 WEST MAIN STREET",
            "city": "TIPP CITY",
            "state": "OH",
            "postal_code": "45371",
            "telephone_number": "937-667-7711",
            "fax_number": "937-667-8067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1483 WEST MAIN STREET",
            "city": "TIPP CITY",
            "state": "OH",
            "postal_code": "45371",
            "telephone_number": "937-667-7711",
            "fax_number": "937-667-8067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILD AND ADOLESCENT SPECIALTY CARE OF DAYTON INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GALEMMO",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "NURSING OFFICE MANAGER",
        "authorized_official_telephone_number": "937-667-7711",
        "authorized_official_credential": "L.P.N."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0382910",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tipp City, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.