Countryside Acute Care Llc is a medicare enrolled primary clinic (Nurse Practitioner - Family) in South Vienna, Ohio. The current practice location for Countryside Acute Care Llc is Main St, South Vienna, Ohio. For appointments, you can reach them via phone at
(937) 000-0000. The mailing address for Countryside Acute Care Llc is 931 Wilson Rd, South Vienna, Ohio and phone number is () -.
Countryside Acute Care Llc is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its
NPI number is 1548974009. This medical practice
accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at
(937) 000-0000.
Primary Care Clinic Profile
| Full Name | Countryside Acute Care Llc |
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| Speciality | Nurse Practitioner |
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| Location | Main St, South Vienna, Ohio |
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| Authorized Official Name and Position | Derrick Marple (OWNER) |
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| Authorized Official Contact | 9376059294 |
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| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
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Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Countryside Acute Care Llc
931 Wilson Rd
South Vienna
OH 45369-9747
Ph: () - | Countryside Acute Care Llc
Main St
South Vienna
OH 45369
Ph: (937) 000-0000 |
NPI Details:
| NPI Number | 1548974009 |
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| Provider Enumeration Date | 01/10/2023 |
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| Last Update Date | 05/10/2023 |
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Medicare PECOS Information:
| Medicare PECOS PAC ID | 9436524485 |
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| Medicare Enrollment ID | O20230405002280 |
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Medical Identifiers
Medical identifiers for Countryside Acute Care Llc such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1548974009 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 208000000X | Pediatrics | (* (Not Available)) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Countryside Acute Care Llc acts as a billing entity for following providers:
| Provider Name | Derrick Marple |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1750037560
PECOS PAC ID: 4688060429
Enrollment ID: I20220405000533 |
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