Active NPI
Foundation Health Care Inc.
- Family Medicine Physician
- Poland, OH
National Provider Identifier
1083828974
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 35-049373
- 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
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 35-049373 | OH | Primary |
| Family Medicine Physician | 207Q00000X | 35-04-7881 | OH | |
| Internal Medicine Physician | 207R00000X | 34-00-5052 | OH | |
| Internal Medicine Physician | 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073597472 | Other | NPI | |
| 1467436261 | Other | NPI | |
| FO9371331 | Other | OH | PTAN |
| 1588630404 | Other | NPI | |
| 1952385965 | Other | NPI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
Other NPIs on the same Medicare enrollment 2
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Family Medicine Physician
- Youngstown, OH
- NPI 1619090891
O20071106000311
National Provider Directory
National Provider DirectoryLocations
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.
-
- Internal Medicine Physician
- Youngstown, OH
- NPI 1073597472
-
- Family Medicine Physician
- Boardman, OH
- NPI 1467436261
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.