Provider Demographics
NPI:1265498604
Name:BAUERLE, JAY A (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:A
Last Name:BAUERLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 COOPER RD STE 212
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8735
Mailing Address - Country:US
Mailing Address - Phone:614-627-1400
Mailing Address - Fax:614-882-6097
Practice Address - Street 1:495 COOPER RD STE 212
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8735
Practice Address - Country:US
Practice Address - Phone:614-627-1400
Practice Address - Fax:614-882-6097
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV239942084N0400X
IN01043948A2084N0400X
OH0953552084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV381001773Medicaid
IN200368430Medicaid
OH3056428Medicaid
IN000000392104OtherANTHEM BXBS
INH04187Medicare UPIN
OH3056428Medicaid
WVBA4292552Medicare UPIN
WV381001773Medicaid