Individual provider Active NPI

Casey McConnell Gilmore, PA-C

  • Physician Assistant
  • Cincinnati, OH
National Provider Identifier
1013290782
Registry record updated Oct 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.003344 Issued in OH
Practice address
375 Dixmyth Ave
Department of Emergency Medicine
Cincinnati, OH 45220-2475
Phone
(513) 862-2989
NPI assigned
Sep 20, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50.003344 OH Primary

Addresses

Primary practice location

375 Dixmyth Ave
Department of Emergency Medicine
Cincinnati, OH 45220-2475

Mailing address

8912 Sandymar Dr
Cincinnati, OH 45242-7322
Phone (513) 305-9722

Other practice location 1

1293 E Parkdale Ave
Manistee, MI 49660-8904
Phone (231) 398-1840

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221026002788 MI Practitioner - Physician Assistant 3274709951 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Munson Healthcare Manistee Hospital 29 clinicians

Practice addresses (Care Compare)

1293 E Parkdale Ave
Manistee, MI 49660-8904

Hospital & facility affiliations

  • Munson Healthcare Manistee Hospital Hospital, Manistee, MI, CCN 230303

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
50.003344OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Munson Healthcare Manistee Hospital CurrentSince Oct 1, 2022 Accepting new patients
Munson Healthcare Manistee Hospital CurrentSince Oct 1, 2022 Accepting new patients
Munson Healthcare Manistee Hospital Past Accepting new patients
Helen Holtman, M.D. and Associates Inc. Past Accepting new patients

Locations

1391 E Parkdale Ave
Manistee, MI 49660
Phone (231) 398-1760

1465 E Parkdale Ave
Manistee, MI 49660
Phone (231) 398-1000

1293 E Parkdale Ave
Manistee, MI 49660
Phone (231) 398-1735

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1316476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665360000000",
    "number": "1013290782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8912 SANDYMAR DR",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452427322",
            "telephone_number": "513-305-9722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 DIXMYTH AVE",
            "address_2": "DEPARTMENT OF EMERGENCY MEDICINE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452202475",
            "telephone_number": "513-862-2989"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1293 E Parkdale Ave",
            "address_purpose": "LOCATION",
            "city": "Manistee",
            "state": "MI",
            "postal_code": "496608904",
            "country_code": "US",
            "telephone_number": "231-398-1840",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GILMORE",
        "first_name": "CASEY",
        "middle_name": "MCCONNELL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-20",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.003344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

Verify at the official NPI Registry.