Individual provider Active NPI

Carly Rae Tepsick, FNP-C

  • Family Nurse Practitioner
  • Poland, OH
National Provider Identifier
1073268249
Registry record updated Oct 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN.CNP.0030759 Issued in OH
Practice address
715 E Western Reserve Rd
Poland, OH 44514-3358
Phone
(330) 726-3204
Fax
(330) 729-9316
NPI assigned
Feb 16, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X APRN.CNP.0030759 OH
Family Nurse Practitioner 363LF0000X APRN.CNP.0030759 OH Primary

Addresses

Primary practice location

715 E Western Reserve Rd
Poland, OH 44514-3358

Mailing address

715 E Western Reserve Rd
Poland, OH 44514-3358
Phone (330) 726-3204

Other practice location 1

627 Eastland Ave SE Ste 301
Warren, OH 44484-4501
Phone (330) 392-3099

Other practice location 2

1001 Belmont Ave
Youngstown, OH 44504-1003
Phone (330) 747-6446

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
I20220413001020 OH Practitioner - Nurse Practitioner 9739575077 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Health Physicians Youngstown Specialty Care LLCGroup PAC ID 3476950296, 463 clinicians

Practice addresses (Care Compare)

715 E Western Reserve Rd
FL 2
Poland, OH 44514-3358
Phone (330) 965-3363

Hospital & facility affiliations

  • MH St Elizabeth Youngstown Hospital Hospital, Youngstown, OH, CCN 360064
  • HMHP St Elizabeth Boardman Health Center Hospital, Boardman, OH, CCN 360276

Merit-based Incentive Payment System (MIPS)

Final score
83.94 of 100Reported as group
Quality
71.12
Promoting interoperability
100
Improvement activities
40
Cost
75.36

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing

Practice roles

OrganizationSpecialtyStatusNew patients
Triad Health Services, LLC Cardiovascular Disease CurrentSince Mar 7, 2022 Accepting new patients
Mercy Health Physicians Youngstown Specialty Care LLC CurrentSince Nov 5, 2023 Accepting new patients
Mercy Health Physicians Youngstown Specialty Care LLC CurrentSince Nov 5, 2023 Accepting new patients
Mercy Health Physicians Youngstown Specialty Care LLC Cardiovascular Disease Current Accepting new patients
The Surgery Center at Southwoods, LLC Past Accepting new patients

Locations

410 W 10th Ave
Columbus, OH 43210
Phone (614) 293-5905

47 State St
Struthers, OH 44471
Phone (330) 722-3311

627 Eastland Ave SE
Ste 301
Warren, OH 44484
Phone (330) 392-3099

1001 Belmont Ave
Youngstown, OH 44504
Phone (330) 747-1106

100 Debartolo Pl
Ste 200
Youngstown, OH 44512
Phone (330) 965-7828

715 E Western Reserve Rd
Fl 2
Youngstown, OH 44514
Phone (330) 726-3204

7629 Market St
Ste 250
Youngstown, OH 44512
Phone (330) 729-9480

715 E Western Reserve Rd
Youngstown, OH 44514
Phone (330) 726-3204

Interoperability endpoints

  • Direct secure messaging: ctepsick1344818@direct.bsmhealth.org

Organizations & group practices 5

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 3

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": "1644969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698278400000",
    "number": "1073268249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 E WESTERN RESERVE RD",
            "city": "POLAND",
            "state": "OH",
            "postal_code": "445143358",
            "telephone_number": "330-726-3204",
            "fax_number": "330-729-9316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 E WESTERN RESERVE RD",
            "city": "POLAND",
            "state": "OH",
            "postal_code": "445143358",
            "telephone_number": "330-726-3204",
            "fax_number": "330-729-9316"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "627 Eastland Ave SE Ste 301",
            "address_purpose": "LOCATION",
            "city": "Warren",
            "state": "OH",
            "postal_code": "444844501",
            "country_code": "US",
            "telephone_number": "330-392-3099",
            "fax_number": "330-395-1721",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1001 Belmont Ave",
            "address_purpose": "LOCATION",
            "city": "Youngstown",
            "state": "OH",
            "postal_code": "445041003",
            "country_code": "US",
            "telephone_number": "330-747-6446",
            "fax_number": "330-747-6843",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TEPSICK",
        "first_name": "CARLY",
        "middle_name": "RAE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-16",
        "last_updated": "2023-10-26",
        "certification_date": "2023-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OH",
            "license": "APRN.CNP.0030759",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.0030759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Poland, OH

Sources for this page

Verify at the official NPI Registry.