NPIMap

Organization Active NPI

Skill Doc 101, LLC

  • Internal Medicine Physician
  • Canton, OH
National Provider Identifier
1043647803
Registry record updated Jun 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
SKILL DOC 101, LLC
Practice address
236 3Rd St SW
Canton, OH 44702-1607
Phone
(330) 754-4431
Fax
(330) 244-8839
NPI assigned
Oct 10, 2013
Last updated
Jun 8, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2025

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

Authorized official

Name
Brian McClainNPI 1821038043
Title
Ceo
Phone
(330) 754-4431

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

236 3Rd St SW
Canton, OH 44702-1607

Mailing address

236 3Rd St SW
Canton, OH 44702-1607
Phone (330) 754-4431

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131231001912 OH Part B Supplier - Clinic/Group Practice 1658509369 Receives reassigned benefits from 79 practitioners

National Provider Directory

National Provider Directory

Locations

3328 13th St NW
Canton, OH 44708
Phone (330) 259-1145

3660 Greentree Ave SW
Canton, OH 44706
Phone (330) 484-5888

4774 Munson St NW
Ste 103
Canton, OH 44718
Phone (330) 244-8975

4774 Munson St NW
Ste 401
Canton, OH 44718
Phone (330) 754-4431

1082 Kensington Rd NE
Carrollton, OH 44615
Phone (330) 627-6207

1525 N Crater Ave
Dover, OH 44622
Phone (330) 364-4436

150 Omni Lake Pkwy
Hudson, OH 44236
Phone (234) 284-4504

2550 University Dr SE
Massillon, OH 44646
Phone (330) 833-7229

Practitioners & affiliated clinicians

Practitioners 80

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 80

NPI Registry JSON

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

{
    "created_epoch": "1381363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749340800000",
    "number": "1043647803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "236 3RD ST SW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447021607",
            "telephone_number": "330-754-4431",
            "fax_number": "330-244-8839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "236 3RD ST SW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447021607",
            "telephone_number": "330-754-4431",
            "fax_number": "330-244-8839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKILL DOC 101, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-10",
        "last_updated": "2025-06-08",
        "certification_date": "2025-06-08",
        "status": "A",
        "authorized_official_last_name": "MCCLAIN",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "330-754-4431"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.