Portage Internal Medicine Associates LLC

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

34006535 Issued in OH

Legal business name

PORTAGE INTERNAL MEDICINE ASSOCIATES LLC

Practice address

503 Overlook Dr
Kent, OH 44240-5824

Phone

(330) 645-6463

Fax

(330) 645-6462

NPI assigned

Sep 6, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Dean J Deperro Sr., DONPI 1568567410

Title

Physican

Phone

(330) 346-0800

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Dean Deperro Sr., DO

  • Internal Medicine Physician
  • Barberton, OH
  • NPI 1568567410
  Medicare reassignment NPD Authorized official
• Mary D Deperro, LISW

  • Clinical Social Worker
  • Ravenna, OH
  • NPI 1396866851
  NPD (past)

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

{
    "created_epoch": "1189036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703030400000",
    "number": "1083809784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 45519",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "441450519",
            "telephone_number": "800-514-4390",
            "fax_number": "440-808-3675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 OVERLOOK DR",
            "city": "KENT",
            "state": "OH",
            "postal_code": "442405824",
            "telephone_number": "330-645-6463",
            "fax_number": "330-645-6462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTAGE INTERNAL MEDICINE ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-06",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-20",
        "status": "A",
        "authorized_official_last_name": "DEPERRO",
        "authorized_official_first_name": "DEAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PHYSICAN",
        "authorized_official_telephone_number": "330-346-0800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "OH",
            "license": "34006535",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2192863",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD CARE",
            "identifier": "DO7407",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ellen Kathleen Pochedley
• Emily Poling, PA-C
• Adam Polster
• Myles Poole
• Portage County Traumatic Brain Injury Clubhouse
• Wanda Jean Porter
• Tiffany Poth
• Kirsten Marie Powell
• Lasheda Powell
• Stephanie Nichole Powell, CT

• Geriatric Medicine (Internal Medicine) Physician in Kent, OH
• Providers in Kent, OH by specialty
• Geriatric Medicine (Internal Medicine) Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2023; 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.