Healthsource of Ohio, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Cincinnati, OH
NPI 1942646799 · NPPES record last updated Sep 18, 2024
Key facts
- NPI
- 1942646799
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- HEALTHSOURCE OF OHIO, INC.
- Practice address
- 8000 Five Mile Rd
Suite 207
Cincinnati, OH 45230-4523 - Phone
- (513) 474-2870
- Fax
- (513) 688-8585
- NPI assigned
- May 21, 2013
- Organization subpart
- No
Authorized official
- Name
- Joseph W Prather II, MD
- Title
- Ceo
- Phone
- (513) 707-4041
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 24
Corporate family (same tax ID) 44
Practitioners 57
-
Kathleen M Adkins, NURSE PRACTITIONER
-
Anya C. Bauman, MD
-
Jessica Beebe, DO
-
Sujata Bhattacharjee, CNP
-
Holly Binnig, MD
-
Mary A Bishop, MD
-
Michael Bruner, PSYD
-
Stephanie Kristen Burkhard, M.A., QMHP
-
Kane Carlock, LMHCA
-
Roger Kai-Di Chang, M.D.
-
Karla Marie Dean, FNP-C
-
Hannah Dearworth, DO
-
Sahara Dawn Dorsey, BC-FNP
-
Brittney Garrigus, FNP
-
Josie Ann Gast, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Federally qualified health center certification: CCN 361039
- Legal name
- HEALTHSOURCE OF OHIO, INC.
- Doing business as
- HEALTHSOURCE ANDERSON OBGYN
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jan 22, 2014
- Last certification
- Jan 22, 2014
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 1, 1978 in OH
- Enrollment address
- 8000 5 Mile Rd
Ste 207
Cincinnati, OH 45230-2187
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Gail Koford |
Corporate Director |
May 28, 2024 | |
| Douglas McDonald |
Corporate Director |
Apr 28, 2022 | |
| Patrick Hayes |
Corporate Director |
Jan 30, 2025 | |
| Stephen Hood |
Corporate Director |
Mar 31, 2022 | |
| Joseph W Prather |
Corporate Officer |
May 28, 2024 | |
| W-2 Managing Employee |
May 28, 2024 | ||
| Tiffany Mattingly |
Corporate Director |
Apr 28, 2022 | |
| Mark McAndrew |
Corporate Director |
May 27, 2017 | |
| Jina L Bohl |
Corporate Director |
Mar 28, 2019 | |
| Konstantinos Elefter |
Corporate Director |
Dec 10, 2020 | |
| Cynthia L. Wright Sellers |
Corporate Director |
Jun 29, 2017 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Healthsource Batavia Family Practice |
Federally qualified health center | Operational/Managerial Control (100%) | Oct 1, 1976 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131014001266 | OH | Part a Provider - Federally Qualified Health Center (FQHC) | 2264328749 | Practice locations: Cincinnati, OH |
National Provider Directory
- Tax ID family
- West Union Family Healt
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
8000 Five Mile Rd
Suite 207
Cincinnati, OH 45230-4523
Mailing address
424 Wards Corner Rd Ste 200
Loveland, OH 45140-6966
Phone (513) 707-4041
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0102895 | Medicaid | OH |
Other names
- HealthSource: Anderson OB/Gyn
Other providers in Cincinnati, OH
- Healthsource of Ohio, Inc.
- Healthsource of Ohio, Inc.
- Healthsource of Ohio, Inc.
- Healthsource of Ohio, Inc.
- Healthsource of Ohio, Inc.
- Healthspan Inc.
- Healthspan QBM
- Healthstars Home Care LLC
- Healthtrends of Ohio LLC
- Healthy Beginnings Inc
All providers in Cincinnati, OH · Federally Qualified Health Center (FQHC) in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.