NPIMap

Organization Active NPI

Licking Memorial Professional Corp

Doing business as Licking Memorial Endocrinology

  • Endocrinology, Diabetes & Metabolism Physician
  • Newark, OH
National Provider Identifier
1073822938
Registry record updated Jul 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
Legal business name
LICKING MEMORIAL PROFESSIONAL CORP
Doing business as
Licking Memorial Endocrinology
Practice address
1272 W Main St
BLDG 2 Ste 3
Newark, OH 43055-2004
Phone
(740) 348-7950
Fax
(740) 348-7951
NPI assigned
Sep 27, 2010
Last updated
Jul 31, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2012

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

Authorized official

Name
Cynthia L Webster
Title
VP of Financial Services
Phone
(740) 348-4518

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X Primary

Addresses

Primary practice location

1272 W Main St
BLDG 2 Ste 3
Newark, OH 43055-2004

Mailing address

1272 W Main St
BLDG 2 Ste 3
Newark, OH 43055-2004
Phone (740) 348-7950

Other names 1

  • Licking Memorial Endocrinology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031203000131 OH Part B Supplier - Clinic/Group Practice 6204740731 Receives reassigned benefits from 282 practitioners
45 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Newark, OH; Pataskala, OH; Utica, OH; Heath, OH; Hebron, OH; Johnstown, OH; Granville, OH

Other NPIs on the same Medicare enrollment 45

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 45

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D2043631Licking Memorial Endocrinology1272 W Main St, Newark, OH 43055Certificate of waiverJul 5, 2028

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1285545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343692800000",
    "number": "1073822938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1272 W MAIN ST",
            "address_2": "BLDG 2 STE 3",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430552004",
            "telephone_number": "740-348-7950",
            "fax_number": "740-348-7951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1272 W MAIN ST",
            "address_2": "BLDG 2 STE 3",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430552004",
            "telephone_number": "740-348-7950",
            "fax_number": "740-348-7951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LICKING MEMORIAL PROFESSIONAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-27",
        "last_updated": "2012-07-31",
        "status": "A",
        "authorized_official_last_name": "WEBSTER",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "VP OF FINANCIAL SERVICES",
        "authorized_official_telephone_number": "740-348-4518"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Licking Memorial Endocrinology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newark, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.