Individual provider Active NPI

Kyle Edwin Gantz, D.C.

  • Chiropractor
  • Bellefontaine, OH
National Provider Identifier
1972653145
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3540 Issued in OH
Practice address
1405 S Detroit St
Bellefontaine, OH 43311-9709
Phone
(937) 592-6321
Fax
(937) 592-7644
NPI assigned
Jan 11, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3540 OH Primary

Addresses

Primary practice location

1405 S Detroit St
Bellefontaine, OH 43311-9709

Mailing address

645 Eastern Ave
Bellefontaine, OH 43311-2613

Other identifiers 1

IdentifierTypeStateIssuer
2552821MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041130000247 OH Practitioner - Chiropractic 9436114600 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1405 S Detroit St
Bellefontaine, OH 43311-9709
Phone (937) 592-6321

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Gantz Chiropractic, LLC Chiropractor CurrentSince Jan 1, 2017 Accepting new patients

Locations

1405 S Detroit St
Bellefontaine, OH 43311
Phone (937) 592-6321

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1972653145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 EASTERN AVE",
            "city": "BELLEFONTAINE",
            "state": "OH",
            "postal_code": "433112613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 S DETROIT ST",
            "city": "BELLEFONTAINE",
            "state": "OH",
            "postal_code": "433119709",
            "telephone_number": "937-592-6321",
            "fax_number": "937-592-7644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANTZ",
        "first_name": "KYLE",
        "middle_name": "EDWIN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OH",
            "license": "3540",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2552821",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellefontaine, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.