Provider Demographics
NPI:1992798441
Name:TROUTEN, JASMINE T (MD)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:T
Last Name:TROUTEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-8054
Mailing Address - Fax:
Practice Address - Street 1:2050 KENNY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3502
Practice Address - Country:US
Practice Address - Phone:614-293-8054
Practice Address - Fax:614-293-4890
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063673207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0081411000Medicaid
OH0109297Medicaid
WV55035705701OtherWV COMPENSATION
18995AOtherHEALTH PLAN OF UPPER OH V
5503570579A51OtherANTHEM BCBS
001718161OtherMOUNTAIN STATE BCBS
0595950OtherUMWA
OH23382908500OtherOHIO BWC
001718161OtherMOUNTAIN STATE BCBS
0595950OtherUMWA
001718161OtherMOUNTAIN STATE BCBS
110175573Medicare ID - Type UnspecifiedRAILROAD MEDICARE