Kimberly Sue Ciccero, DPM
Individual provider Active NPI Foot & Ankle Surgery Podiatrist · Galion, OH
NPI 1083666036 · NPPES record last updated Sep 25, 2012
Key facts
- NPI
- 1083666036
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Foot & Ankle Surgery Podiatrist 213ES0103X
- License
- 36003436 (OH)
- Practice address
- 396 Portland Way North
Galion, OH 44833 - Phone
- (419) 468-3668
- Fax
- (419) 462-5037
- NPI assigned
- May 17, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Podiatry
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
13333 Lorain Ave
Cleveland, OH 44111-3400
Phone (216) 941-3338
27900 Euclid Ave
Euclid, OH 44132-3544
Phone (216) 731-3370
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 1-10 |
| Removal of nail tissue | 696 |
| Removal or shaving of skin growth | 197 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060504001018 | OH | Practitioner - Podiatry | 1456362441 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36003436 | OH | MD | Foot & Ankle Surgery Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cornerstone Podiatry LLC | Current | Accepting new patients | |
| Cornerstone Podiatry LLC | Foot & Ankle Surgery | Current |
Accepting new patients |
| Dixie a. Dooley, DPM, Inc. | Foot & Ankle Surgery | Past | Accepting new patients |
| Community Foot and Ankle of Mentor Inc. | Past |
Accepting new patients |
Locations
13333 Lorain Ave
Cleveland, OH 44111
Phone (216) 696-6363
27900 Euclid Ave
Euclid, OH 44132
Phone (216) 331-3318
20455 Lorain Rd
Ste 101
Fairview Park, OH 44126
Phone (440) 333-5350
29127 Euclid Ave
Wickliffe, OH 44092
Phone (216) 731-3370
Interoperability endpoints
- https://api.platform.athenahealth.com/10129/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 36003436 | OH | Yes |
Addresses
Primary practice location
396 Portland Way North
Galion, OH 44833
Mailing address
3255 E Livingston Ave
PO Box 27940
Columbus, OH 43227-1923
Phone (614) 239-9444
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 986832 | Other | OH | COVENTRY |
| 7970774 | Other | OH | AETNA |
| 310945970 | Other | OH | GREAT WEST |
| 1366529653 | Other | OH | MEDICARE NPI |
| 1699074393 | Other | OH | MEDICARE NPI |
| 000000252794 | Other | OH | UNISON |
| 000000580187 | Other | OH | ANTHEM |
| 2657843 | Medicaid | OH | |
| 5340555 | Other | OH | CIGNA |
| 986832 | Other | OH | FIRST HEALTH NETWORK |
Other providers in Galion, OH
- Kamal Chaban
- Olivia Ann Cheney
- Devis Chokshi
- Christina Angelee Williams
- Raygan Ciballi
- City of Galion
- City of Galion
- Heather Cleveland
- Ernie Ray Clifton II
- Karen Renee Clifton
All providers in Galion, OH · Foot & Ankle Surgery Podiatrist in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 25, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.