| NPI |
1043299274 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
| Entity Type Code |
1 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
| Provider Last Name Legal Name |
DEAN |
The last name of the provider. If the provider is an individual, this is the legal name. |
| Provider First Name |
LAURIAN |
The first name of the provider, if the provider
is an individual. |
| Provider Middle Name |
MARK |
The middle name of the provider, if the provider
is an individual. |
| Provider Credential Text |
M.D. |
The city name in the location address of the provider being identified. |
| Provider First Line Business Practice Location Address |
543 TAYLOR AVE |
The State code in the location of the provider
being identified. |
| Provider Business Practice Location Address City Name |
COLUMBUS |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
| Provider Business Practice Location Address State Name |
OH |
The country code in the location address of the provider being identified. |
| Provider Business Practice Location Address Postal Code |
432031278 |
The telephone number associated with the location address of the provider being identified. |
| Provider Business Practice Location Address Country Code If outside U S |
US |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Provider Business Practice Location Address Telephone Number |
6142938315 |
The date that a record was last updated or changed. |
| Provider Business Practice Location Address Fax Number |
6142936935 |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
| Provider Enumeration Date |
1/16/2006 |
The first name of the authorized official. |
| Last Update Date |
4/26/2024 |
The date that a record was last updated or changed. |
| Provider Gender Code |
M |
The code designating the provider’s gender if the provider is a person. |
| Healthcare Provider Taxonomy Code 1 |
2085R0202X |
The code designating the provider’s gender if the provider is a person. |
| Provider License Number 1 |
35077603 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Provider License Number State Code 1 |
OH |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Healthcare Provider Primary Taxonomy Switch 1 |
N |
|
| Healthcare Provider Taxonomy Code 2 |
2085R0204X |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Provider License Number 2 |
35.077603 |
|
| Provider License Number State Code 2 |
OH |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
| Healthcare Provider Primary Taxonomy Switch 2 |
Y |
|
| Other Provider Identifier 1 |
2157428 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier Type Code 1 |
05 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier State 1 |
OH |
|
| Other Provider Identifier 2 |
300125121 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier Type Code 2 |
01 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier State 2 |
OH |
|
| Other Provider Identifier Issuer 2 |
RR MEDICARE |
|
| Is Sole Proprietor |
N |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
| NPI Certification Date |
4/26/2024 |
|