Odera Mbanugo, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35.148038 Issued in OH

Practice address

4320 Cleveland Ave SW
Canton, OH 44707

Phone

(330) 484-2584

NPI assigned

Jun 11, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aultman North Canton Medical GroupGroup PAC ID 4082605266, 48 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Aultman Hospital Hospital, Canton, OH, CCN 360084

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: odera.mbanugo@direct.aultman.org
• Direct secure messaging: ombanugo95118@mymichiganhealth.midirect.net

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.

• Aultman North Canton Medical Group

  • Multi-Specialty Clinic/Center
  • North Canton, OH
  • NPI 1245257088
  Medicare reassignment Care Compare group NPD
• North Canton Medical Foundation

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • North Canton, OH
  • NPI 1649383340
  NPD (past)
• Mymichigan Medical Center Midland

  • Multi-Specialty Clinic/Center
  • Midland, MI
  • NPI 1205889490

  Family Medicine

  NPD (past)
• Mymichigan Medical Center Midland

  • Anesthesiology Physician
  • Midland, MI
  • NPI 1649010455
  NPD (past)

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

• Aultman Hospital

  • General Acute Care Hospital
  • Canton, OH
  • NPI 1356366991
  Care Compare affiliation

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

{
    "created_epoch": "1591833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686268800000",
    "number": "1053936443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80690",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447080690",
            "telephone_number": "330-363-7444",
            "fax_number": "330-363-7770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4320 CLEVELAND AVE SW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "44707",
            "telephone_number": "330-484-2584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MBANUGO",
        "first_name": "ODERA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-06-11",
        "last_updated": "2023-06-09",
        "certification_date": "2023-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.148038",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sharaya Monique Mayo
• Amy Mays, L.M.T.
• Kurtis Alexander Mayz, MD
• Felicia Marie Mazzei
• Cameron Michael Mazziotta, CDCA
• Caroline Ngwakfi Mbobi
• Alex Sean McArthur
• Ashley Marie McAvinew, APRN
• Benjamin McAvinew, APRN
• Jodi McAvinew, RN

• Family Medicine Physician in Canton, OH
• Providers in Canton, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.