NPIMap

Organization Active NPI

Samaritan Family Care Inc

Doing business as Huber Heights Internal Medicine

  • Internal Medicine Physician
  • Huber Heights, OH
National Provider Identifier
1972625606
Registry record updated Nov 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
SAMARITAN FAMILY CARE INC
Doing business as
Huber Heights Internal Medicine
Practice address
6251 Good Samaritan Way
Suite 210B
Huber Heights, OH 45424-5253
Phone
(937) 233-2055
Fax
(937) 233-5479
NPI assigned
Apr 4, 2007
Last updated
Nov 8, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
SAMARITAN FAMILY CARE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 8, 2013

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

Authorized official

Name
Kenneth Prunier
Title
Ceo President
Phone
(937) 208-8252

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

6251 Good Samaritan Way
Suite 210B
Huber Heights, OH 45424-5253

Mailing address

6251 Good Samaritan Way
Suite 210B
Huber Heights, OH 45424-5253
Phone (937) 233-2055

Other identifiers 1

IdentifierTypeStateIssuer
0372878MedicaidOH

Other names 1

  • Huber Heights Internal Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040203000210 OH Part B Supplier - Clinic/Group Practice 5092608372 Receives reassigned benefits from 160 practitioners
19 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Englewood, OH; Vandalia, OH; New Lebanon, OH; Lewisburg, OH; Huber Heights, OH; Dayton, OH; Brookville, OH

Other NPIs on the same Medicare enrollment 19

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

View all 19

National Provider Directory

National Provider Directory
Part of
Samaritian Family Care

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383868800000",
    "number": "1972625606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6251 GOOD SAMARITAN WAY",
            "address_2": "SUITE 210B",
            "city": "HUBER HEIGHTS",
            "state": "OH",
            "postal_code": "454245253",
            "telephone_number": "937-233-2055",
            "fax_number": "937-233-5479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6251 GOOD SAMARITAN WAY",
            "address_2": "SUITE 210B",
            "city": "HUBER HEIGHTS",
            "state": "OH",
            "postal_code": "454245253",
            "telephone_number": "937-233-2055",
            "fax_number": "937-233-5479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMARITAN FAMILY CARE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAMARITAN FAMILY CARE INC",
        "enumeration_date": "2007-04-04",
        "last_updated": "2013-11-08",
        "status": "A",
        "authorized_official_last_name": "PRUNIER",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "CEO PRESIDENT",
        "authorized_official_telephone_number": "937-208-8252"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0372878",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Huber Heights Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Huber Heights, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2013; 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.

Verify at the official NPI Registry.