Jack Siebenaler II, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35053850 Issued in OH

Practice address

3232 Navarre Ave
Oregon, OH 43616-3312

Phone

(419) 691-0636

Fax

(419) 693-1412

NPI assigned

Feb 27, 2006

Last updated

Feb 13, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Jack Siebenaler II MD, Inc

  • Primary Care Clinic/Center
  • Oregon, OH
  • NPI 1255514873
  NPD (past) Authorized official
• Oregon Urgent Care

  • Urgent Care Clinic/Center
  • Oregon, OH
  • NPI 1215022298
  NPD (past) Authorized official

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

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329091200000",
    "number": "1982670212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3232 NAVARRE AVE",
            "city": "OREGON",
            "state": "OH",
            "postal_code": "436163312",
            "telephone_number": "419-691-0636",
            "fax_number": "419-693-1412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3232 NAVARRE AVE",
            "city": "OREGON",
            "state": "OH",
            "postal_code": "436163312",
            "telephone_number": "419-691-0636",
            "fax_number": "419-693-1412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIEBENALER",
        "first_name": "JACK",
        "name_suffix": "II",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-27",
        "last_updated": "2012-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35053850",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0636539",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shayne Erman DPM LLC
• Tasneem Shbat
• Tanuja Shekhawat, DMD
• Kendra Shellhammer, LMT
• Sherri Sherock, CFNC, CHC, CPT
• Kristi R Sigler, M.D.
• Vaishali Sinha, M.D.
• Adrian Smith
• Colleen K Smith, M.A. CCC-A
• Kay A Smith, CNM

• Family Medicine Physician in Oregon, OH
• Providers in Oregon, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.