NPIMap

Individual provider Active NPI

Edgar R Santillan, M.D.

  • Hospitalist Physician
  • Centerville, OH
National Provider Identifier
1902823867
Registry record updated Mar 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
35.075548 Issued in OH
Practice address
2400 Miami Valley Dr
Centerville, OH 45459-4774
Phone
(937) 556-4324
Fax
(937) 439-3786
NPI assigned
Jul 16, 2006
Last updated
Mar 23, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35-075548 OH
Hospitalist Physician 208M00000X 35.075548 OH Primary

Addresses

Primary practice location

2400 Miami Valley Dr
Centerville, OH 45459-4774

Mailing address

PO Box 771861
Detroit, MI 48277-1861
Phone (937) 556-4324

Other identifiers 1

IdentifierTypeStateIssuer
2489016MedicaidOH

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
I20040805001335 OH Practitioner - Internal Medicine 6507837044 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3205 Woodman Dr
Dayton, OH 45420-1143
Phone (937) 556-4324

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
48.88 of 100Reported as individual
Quality
68.35
Improvement activities
0
Cost
71.8

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35-075548OHMDInternal Medicine Physician
35066KYMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Edgar Santillan MD LLC Internal Medicine CurrentSince Dec 16, 2014 Accepting new patients
Meadowview Physician Practice LLC Past Accepting new patients
Glenn R. Womack M.D. PSC Past Accepting new patients

Locations

2400 Miami Valley Dr
Dayton, OH 45459
Phone (937) 208-8394

3205 Woodman Dr
Kettering, OH 45420
Phone (937) 298-4417

3535 Southern Blvd
Kettering, OH 45429
Phone (937) 298-1221

Organizations & group practices 3

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 5

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": "1153008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679529600000",
    "number": "1902823867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 771861",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482771861",
            "telephone_number": "937-556-4324",
            "fax_number": "937-350-6477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 MIAMI VALLEY DR",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454594774",
            "telephone_number": "937-556-4324",
            "fax_number": "937-439-3786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANTILLAN",
        "first_name": "EDGAR",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-16",
        "last_updated": "2023-03-23",
        "certification_date": "2023-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35-075548",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "OH",
            "license": "35.075548",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2489016",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Centerville, OH

Sources for this page

Verify at the official NPI Registry.