NPIMap

Organization Active NPI

Ohio Department of Mental Retardation and Developmental Disabilities

  • Intellectual Disabilities Intermediate Care Facility
  • Gallipolis, OH
National Provider Identifier
1962544635
Registry record updated Feb 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
OHIO DEPARTMENT OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES
Practice address
2500 Ohio Ave
Gallipolis, OH 45631-1656
Phone
(740) 446-1642
Fax
(740) 446-1341
NPI assigned
Feb 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2009

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

Authorized official

Name
Mr. Kevin Davis
Title
Superintendent
Phone
(740) 446-1642

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X OH Primary

Addresses

Primary practice location

2500 Ohio Ave
Gallipolis, OH 45631-1656

Mailing address

30 E Broad St
Columbus, OH 43215-3414
Phone (614) 466-1970

Other identifiers 3

IdentifierTypeStateIssuer
0136025MedicaidOH
0280799MedicaidOH
0372618MedicaidOH

Other names 1

  • Gallipolis Developmental Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031202000209 OH Part B Supplier - Clinic/Group Practice 0143133181 Receives reassigned benefits from 261 practitioners
28 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Northfield, OH; Youngstown, OH; Toledo, OH; Tiffin, OH; Mt Vernon, OH; Mineral Ridge, OH; Massillon, OH; Huber Heights, OH…

Other NPIs on the same Medicare enrollment 26

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 26

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D0901045Gallipolis Developmental Center2500 Ohio Avenue, Gallipolis, OH 45631Certificate of waiverMay 14, 2027

National Provider Directory

National Provider Directory
Tax ID family
Central Ohio Pyschiatri41 organizations share this tax ID, including this one

Other organizations with this tax ID 40

Organizations that report the same tax identification number in the National Provider Directory.

View all 40

Locations

30 E Broad St
Columbus, OH 43215
Phone (614) 214-5387

2500 Ohio Ave
Gallipolis, OH 45631
Phone (740) 446-1642

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234310400000",
    "number": "1962544635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 E BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432153414",
            "telephone_number": "614-466-1970",
            "fax_number": "614-466-3141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 OHIO AVE",
            "city": "GALLIPOLIS",
            "state": "OH",
            "postal_code": "456311656",
            "telephone_number": "740-446-1642",
            "fax_number": "740-446-1341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OHIO DEPARTMENT OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2009-02-11",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "SUPERINTENDENT",
        "authorized_official_telephone_number": "740-446-1642",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0136025",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0280799",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0372618",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gallipolis Developmental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gallipolis, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2009; 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.