Form and Function Healthcare LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

FORM AND FUNCTION HEALTHCARE LLC

Practice address

4278 Indianola Ave
Columbus, OH 43214-2806

Phone

(419) 235-2823

NPI assigned

Feb 12, 2025

Organization subpart

No

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

Authorized official

Name

Mr. John P Bell II

Title

VP Finance

Phone

(419) 235-2823

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

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

• Jennifer Ann Bell, APRN-CNP

  • Primary Care Nurse Practitioner
  • Columbus, OH
  • NPI 1528616711
  Medicare reassignment NPD

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

{
    "created_epoch": "1739318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741564800000",
    "number": "1932914389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4278 INDIANOLA AVE",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432142806",
            "telephone_number": "419-235-2823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4278 INDIANOLA AVE",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432142806",
            "telephone_number": "419-235-2823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORM AND FUNCTION HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-12",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "status": "A",
        "authorized_official_last_name": "BELL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "419-235-2823",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "II"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Davide Foresi, MD
• Julia Foresi
• Forestways OT LLC
• Forever Care LLC
• Dixon Alfred Fayiah Forleh
• Charles Forman
• Heather R Forman, DPT
• Kelly Ann Forman, LSW
• Michael A Forman, PHD
• Nancy Walker Forman, PHD

• Family Medicine Physician in Columbus, OH
• Providers in Columbus, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.