Active NPI
Morenci Medical Assoc, PC
- Family Medicine Physician
- Wauseon, OH
National Provider Identifier
1962690735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 35-06-8087S
- Legal business name
- MORENCI MEDICAL ASSOC, PC
- Practice address
- 137 S Fulton St
Wauseon, OH 43567-1351 - Phone
- (419) 335-2811
- Fax
- (419) 335-3388
- NPI assigned
- Oct 5, 2007
- Organization subpart
- Yes
- Parent organization
- MORENCI MEDICAL ASSOC, PC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Shivaprasas K Shetty, MD
- Title
- President
- Phone
- (419) 335-2811
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 35-06-8087S | OH | Primary |
Addresses
Primary practice location
137 S Fulton St
Wauseon, OH 43567-1351
Mailing address
137 S Fulton St
Wauseon, OH 43567-1351
Phone (419) 335-2811
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040121001122 | OH | Part B Supplier - Clinic/Group Practice | 3870495849 |
Receives reassigned benefits from 1 practitioner Practice locations: Wauseon, OH |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider Directory- Part of
- Morenci Medical Assoc PC
Locations
240 W Main St
Morenci, MI 49256
Phone (419) 330-2619
137 S Fulton St
Wauseon, OH 43567
Phone (419) 335-2811
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": "1191542400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1191542400000",
"number": "1962690735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "137 S FULTON ST",
"city": "WAUSEON",
"state": "OH",
"postal_code": "435671351",
"telephone_number": "419-335-2811",
"fax_number": "419-335-3388"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "137 S FULTON ST",
"city": "WAUSEON",
"state": "OH",
"postal_code": "435671351",
"telephone_number": "419-335-2811",
"fax_number": "419-335-3388"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MORENCI MEDICAL ASSOC, PC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "MORENCI MEDICAL ASSOC, PC",
"enumeration_date": "2007-10-05",
"last_updated": "2007-10-05",
"status": "A",
"authorized_official_last_name": "SHETTY",
"authorized_official_first_name": "SHIVAPRASAS",
"authorized_official_middle_name": "K",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "419-335-2811",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "OH",
"license": "35-06-8087S",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wauseon, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.