Eddie Dean Davenport, MD

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

35.097215 Issued in OH

Practice address

4881 Sugar Maple Dr
Wright Patterson Afb, OH 45433

Phone

(937) 938-2752

NPI assigned

Aug 30, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX, OH2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Cardiovascular Disease (Cardiology)

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Premier Health Specialists IncGroup PAC ID 5597708594, 576 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Upper Valley Medical Center Hospital, Troy, OH, CCN 360174
• Miami Valley Hospital Hospital, Dayton, OH, CCN 360051
• Wilson Memorial Hospital Hospital, Sidney, OH, CCN 360013

Merit-based Incentive Payment System (MIPS)

Final score

78.62 of 100Reported as group

Quality

58.14

Improvement activities

40

Cost

79.7

Merit-based Incentive Payment System (MIPS)

Final score

81.38 of 100Reported as group

Quality

66.25

Promoting interoperability

100

Improvement activities

40

Cost

71.69

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Premier Health Specialists Inc

  • Internal Medicine Physician
  • Moraine, OH
  • NPI 1194958223
  Medicare reassignment Care Compare group NPD
• Schnitzler Cardiovascular Consultants PLLC

  • Cardiovascular Disease Physician
  • San Antonio, TX
  • NPI 1275632754
  Medicare reassignment NPD
• Premier Health Specialists Inc

  dba Advanced Ankle and Foot Specialists

  • Foot & Ankle Surgery Podiatrist
  • Dayton, OH
  • NPI 1902211287
  NPD
• Premier Heart Associates, Inc

  • Cardiovascular Disease Physician
  • Beavercreek, OH
  • NPI 1538188735
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Miami Valley Hospital

  • General Acute Care Hospital
  • Dayton, OH
  • NPI 1073688354
  Care Compare affiliation
• Shelby County Memorial Hospital Association Inc.

  dba Wilson Health

  • General Acute Care Hospital
  • Sidney, OH
  • NPI 1639174204
  Care Compare affiliation
• Upper Valley Medical Center

  • General Acute Care Hospital
  • Troy, OH
  • NPI 1184638942
  Care Compare affiliation

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565308800000",
    "number": "1962512210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4881 SUGAR MAPLE DR",
            "city": "WRIGHT PATTERSON AFB",
            "state": "OH",
            "postal_code": "454335529",
            "telephone_number": "937-257-1558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4881 SUGAR MAPLE DR",
            "city": "WRIGHT PATTERSON AFB",
            "state": "OH",
            "postal_code": "45433",
            "telephone_number": "937-938-2752"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "122 Wyoming St",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454092731",
            "country_code": "US",
            "telephone_number": "937-223-4461",
            "fax_number": "937-449-7603",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1100 Wilford Hall Loop Bldg 4554",
            "address_purpose": "LOCATION",
            "city": "Jbsa Lackland",
            "state": "TX",
            "postal_code": "78236",
            "country_code": "US",
            "telephone_number": "210-292-6225",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVENPORT",
        "first_name": "EDDIE",
        "middle_name": "DEAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2019-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TX",
            "license": "N3601",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "48089",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OH",
            "license": "35.097215",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0054374",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Philip Cushman III, DO
• Joshua Da Silva, DO
• Nathan Jantz Damiano, MD
• Mischa Dansby, NP
• Amie Daryanani, OTR
• Dayton Vamc
• Mario Enrique De la Barrera, PA-C
• Dylan T. Denker, IDMT
• Justin Denhart Dickson, DO
• John Tyler Dimodica, MD

• Cardiovascular Disease Physician in Wright Patterson Afb, OH
• Providers in Wright Patterson Afb, OH by specialty
• Cardiovascular Disease Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.