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PROVIDENCE MEDICAL GROUP
NPI 1811304595
Podiatrist in Moraine, OH

Active since July 15, 2014
2912 SPRINGBORO RD, SUITE 201, MORAINE, OH 45439(937) 297-8999(937) 297-4852 Get Directions Write a Review

NPPES record last updated: October 28, 2014. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Providence Medical Group NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVIDENCE MEDICAL GROUP (NPI 1811304595) is a healthcare organization registered as a podiatrist in Moraine, Ohio and active in the NPI registry since July 2014. The organization lists Susan Becker, Chief Operating Officer, as its authorized official.

NPPES Registry Identity

NPI1811304595
Entity TypeOrganization
Primary Taxonomy213E00000X
Legal Business NamePROVIDENCE MEDICAL GROUP
Location Address2912 SPRINGBORO RD, SUITE 201Moraine, OH 45439-1674
Mailing Address2912 Springboro Rd, Suite 201Moraine, OH 45439-1674 · (937) 297-8999 · Fax (937) 297-4852
Phone(937) 297-8999
Fax(937) 297-4852
Organization SubpartYesParent: Providence Podiatry
Authorized OfficialSusan BeckerChief Operating Officer · (937) 297-8999
Enumeration DateJuly 15, 2014
Last NPPES UpdateOctober 28, 2014
✔ NPI 1811304595 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPodiatristPodiatric Medicine & Surgery Service Providers
Taxonomy Code213E00000X
License✔ Licensed in OH · 36.003657
Definition
A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy.
2912 SPRINGBORO RD, Moraine, OH 45439
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Other Identifiers 4

Medicaid0083030OH
Other1285952937OH · Individual Npi
Medicaid2380294OH
Medicare PINH198263OH

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. LISA A RHODES CNP
Nurse Practitioner (Family)
2912 SPRINGBORO RD, SUITE 201
MORAINE, OH 45439
Montgomery County (937) 297-8999
PROVIDENCE MEDICAL GROUP, INC.
Radiology (Diagnostic Radiology)
2912 SPRINGBORO RD, SUITE 201
MORAINE, OH 45439
Montgomery County (937) 396-8137
DR. TERREN BURGESS KOLES M.D.
General Practice
2912 SPRINGBORO RD, SUITE
MORAINE, OH 45439
Montgomery County (513) 695-1468
PROVIDENCE HEALTH PARTNERS
Clinic/Center (Research)
2912 SPRINGBORO RD, SUITE 201
MORAINE, OH 45439
Montgomery County (937) 297-8999
MRS. JACQUELINE JUNE DAVIS NURSE PRACTITIONER
Nurse Practitioner (Family)
2912 SPRINGBORO RD
MORAINE, OH 45439
Montgomery County (937) 297-8999
PAULA A KIMPTON NP-C
Nurse Practitioner (Family)
2912 SPRINGBORO RD, SUITE 201
MORAINE, OH 45439
Montgomery County (937) 297-8999

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Providence Medical Group's NPI number?

The NPI number for Providence Medical Group is 1811304595. It was assigned to this organization in the NPPES registry on July 15, 2014.

Where is Providence Medical Group located?

Providence Medical Group is located at 2912 Springboro Rd Suite 201, Moraine, OH 45439. The listed phone number is (937) 297-8999.

What is Providence Medical Group's specialty?

The primary specialty registered for this NPI is Podiatrist with taxonomy code 213E00000X.

When was this NPI record last updated?

The NPPES record for Providence Medical Group was last updated on October 28, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.