Organization Active NPI

Foundation Health Care Inc.

  • Family Medicine Physician
  • Poland, OH
National Provider Identifier
1083828974
Registry record updated Feb 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35-049373 Issued in OH
Legal business name
FOUNDATION HEALTH CARE INC.
Practice address
6615 Clingan Road
Suite a
Poland, OH 44514
Phone
(330) 707-1425
Fax
(330) 757-2814
NPI assigned
May 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2008

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

Authorized official

Name
Michael B Evan, MD
Title
President
Phone
(330) 707-1425

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 35-049373 OH Primary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 35-04-7881 OH
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 34-00-5052 OH
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 35-08-6492 OH

Addresses

Primary practice location

6615 Clingan Road
Suite a
Poland, OH 44514

Mailing address

6615 Clingan Road
Suite a
Poland, OH 44514
Phone (330) 707-1425

Other identifiers 5

IdentifierTypeStateIssuer
1073597472OtherNPI
1467436261OtherNPI
FO9371331OtherOHPTAN
1588630404OtherNPI
1952385965OtherNPI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071106000311 OH Part B Supplier - Clinic/Group Practice 0547357675 Receives reassigned benefits from 2 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Youngstown, OH

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Locations

755 Boardman Canfield Rd
Ste F5
Youngstown, OH 44512
Phone (330) 726-3806

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202688000000",
    "number": "1083828974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6615 CLINGAN ROAD",
            "address_2": "SUITE A",
            "city": "POLAND",
            "state": "OH",
            "postal_code": "44514",
            "telephone_number": "330-707-1425",
            "fax_number": "330-757-2814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6615 CLINGAN ROAD",
            "address_2": "SUITE A",
            "city": "POLAND",
            "state": "OH",
            "postal_code": "44514",
            "telephone_number": "330-707-1425",
            "fax_number": "330-757-2814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNDATION HEALTH CARE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-09",
        "last_updated": "2008-02-11",
        "status": "A",
        "authorized_official_last_name": "EVAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "330-707-1425",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35-049373",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35-04-7881",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "34-00-5052",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35-08-6492",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1073597472",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1467436261",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "FO9371331",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1588630404",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1952385965",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Poland, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2008; 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.