NPIMap

Organization Active NPI

Paulding County Hospital Physician Services

  • Family Medicine Physician
  • Paulding, OH
National Provider Identifier
1891744843
Registry record updated Aug 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PAULDING COUNTY HOSPITAL PHYSICIAN SERVICES
Practice address
1032 W. Wayne St
Paulding, OH 45879-1545
Phone
(419) 399-1104
Fax
(419) 399-5560
NPI assigned
May 8, 2006
Organization subpart
Yes
Parent organization
PAULDING COUNTY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 24, 2023

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

Authorized official

Name
Jeanise Diane Denning
Title
Credentialing
Phone
(419) 399-1104

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X

Addresses

Primary practice location

1032 W. Wayne St
Paulding, OH 45879-1545

Mailing address

1032 W Wayne St
Paulding, OH 45879-1545
Phone (419) 399-1104

Other identifiers 2

IdentifierTypeStateIssuer
2113126MedicaidOH
9299274OtherPTAN

Other names 1

  • PCH Physician Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040218000635 OH Part B Supplier - Clinic/Group Practice 8820983893 Receives reassigned benefits from 28 practitioners
Practice locations: Antwerp, OH; Oakwood, OH; Paulding, OH; Payne, OH

National Provider Directory

National Provider Directory
Part of
Paulding County Hospita

Locations

109 N 1st St
Oakwood, OH 45873
Phone (419) 594-3520

220 W Perry St
Paulding, OH 45879
Phone (419) 399-3771

Practitioners & affiliated clinicians

Practitioners 34

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

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692835200000",
    "number": "1891744843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1032 W WAYNE ST",
            "city": "PAULDING",
            "state": "OH",
            "postal_code": "458791545",
            "telephone_number": "419-399-1104",
            "fax_number": "419-399-5560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1032 W. WAYNE ST",
            "city": "PAULDING",
            "state": "OH",
            "postal_code": "458791545",
            "telephone_number": "419-399-1104",
            "fax_number": "419-399-5560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAULDING COUNTY HOSPITAL PHYSICIAN SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PAULDING COUNTY HOSPITAL",
        "enumeration_date": "2006-05-08",
        "last_updated": "2023-08-24",
        "certification_date": "2023-08-24",
        "status": "A",
        "authorized_official_last_name": "DENNING",
        "authorized_official_first_name": "JEANISE",
        "authorized_official_middle_name": "DIANE",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "419-399-1104"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2113126",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "9299274",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PCH Physician Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PCH Physician Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Paulding, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.