Provider Demographics
| NPI: | 1114107919 |
|---|---|
| Name: | THE CHRIST HOSPITAL MEDICAL ASSOCIATES, LLC |
| Entity type: | Organization |
| Organization Name: | THE CHRIST HOSPITAL MEDICAL ASSOCIATES, LLC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | VP, CHIEF BUSINESS OFFICER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | VICTOR |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | DIPILLA |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 513-585-1295 |
| Mailing Address - Street 1: | 2139 AUBURN AVE # 4-9 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | CINCINNATI |
| Mailing Address - State: | OH |
| Mailing Address - Zip Code: | 45219-2906 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 513-351-9900 |
| Mailing Address - Fax: | 513-366-4480 |
| Practice Address - Street 1: | 2139 AUBURN AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | CINCINNATI |
| Practice Address - State: | OH |
| Practice Address - Zip Code: | 45219-2906 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 513-351-9900 |
| Practice Address - Fax: | 513-366-4480 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | THE CHRIST HOSPITAL |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2007-11-08 |
| Last Update Date: | 2025-01-27 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207QG0300X | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | Group - Multi-Specialty |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 207RG0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| KY | 7100077920 | Medicaid | |
| OH | DO4197 | Other | RAIL ROAD MEDICARE |
| OH | 2958223 | Medicaid | |
| KY | 7100077920 | Medicaid |