Individual provider Active NPI

Angela Mastronardi, D.C., L.L.C.

  • Chiropractor
  • Fairview Park, OH
National Provider Identifier
1083757579
Registry record updated Apr 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2651 Issued in OH
Practice address
21245 Lorain Rd Ste 111
Fairview Park, OH 44126-2138
Phone
(440) 212-1901
NPI assigned
Feb 14, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 27, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2651 OH Primary

Addresses

Primary practice location

21245 Lorain Rd Ste 111
Fairview Park, OH 44126-2138

Mailing address

350 Long Pointe Dr
Avon Lake, OH 44012-2424
Phone (440) 212-1901

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180405001520 OH Practitioner - Chiropractic 7315200201 Reassigns benefits to 1 organization
Practice locations: Cleveland, OH; Fairview Park, OH

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2651OHMDHearing Instrument Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Matthew Gajkowski CurrentSince Dec 18, 2022 Accepting new patients
Dunnigan Chiropractic Chiropractor Past Accepting new patients
Chiropractic & Spinal Rehabilitation Clinic, Inc. Chiropractor PastSince Mar 1, 2011 Accepting new patients

Locations

1458 Copley Rd
Akron, OH 44320
Phone (330) 836-8661

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524787200000",
    "number": "1083757579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 LONG POINTE DR",
            "city": "AVON LAKE",
            "state": "OH",
            "postal_code": "440122424",
            "telephone_number": "440-212-1901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21245 LORAIN RD STE 111",
            "city": "FAIRVIEW PARK",
            "state": "OH",
            "postal_code": "441262138",
            "telephone_number": "440-212-1901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASTRONARDI",
        "first_name": "ANGELA",
        "name_prefix": "Dr.",
        "credential": "D.C., L.L.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-14",
        "last_updated": "2018-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OH",
            "license": "2651",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairview Park, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.