Individual provider Active NPI

Karen Marie Dillard, PA-C

  • Physician Assistant
  • Fairlawn, OH
National Provider Identifier
1063751386
Registry record updated Feb 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
003690 Issued in OH
Practice address
822 Kumho Dr
Suite 202
Fairlawn, OH 44333-9297
Phone
(330) 576-0500
Fax
(330) 576-0467
NPI assigned
Feb 6, 2013
Last updated
Feb 6, 2013By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 6, 2013

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 003690 OH Primary

Addresses

Primary practice location

822 Kumho Dr
Suite 202
Fairlawn, OH 44333-9297

Mailing address

2021 Mount Pleasant St NE
Canton, OH 44721-1438
Phone (330) 413-1156

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130320000439 OH Practitioner - Physician Assistant 6002051117 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chagrin Valley Medical Associates LLCGroup PAC ID 5991150740, 4 clinicians

Practice addresses (Care Compare)

29 N Adams St
Akron, OH 44304-1641
Phone (732) 309-4844

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
003690OHMDPhysician Assistant

Organizations & group practices 4

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

Hospital & facility affiliations 4

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": "1360108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360108800000",
    "number": "1063751386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2021 MOUNT PLEASANT ST NE",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447211438",
            "telephone_number": "330-413-1156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "822 KUMHO DR",
            "address_2": "SUITE 202",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "443339297",
            "telephone_number": "330-576-0500",
            "fax_number": "330-576-0467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DILLARD",
        "first_name": "KAREN",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-02-06",
        "last_updated": "2013-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "003690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairlawn, OH

Sources for this page

Verify at the official NPI Registry.