Individual provider Active NPI

Mariel Bird, D.O.

  • Dermatology Physician
  • Boardman, OH
National Provider Identifier
1093020133
Registry record updated Feb 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
34.012984 Issued in OH
Practice address
987 Boardman Canfield Rd
Boardman, OH 44512-4222
Phone
(330) 965-8760
Fax
(330) 965-9325
NPI assigned
Aug 13, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 006424 AZ
General Practice Physician 208D00000X UO2494 FL
Dermatology Physician 207N00000X 34.012984 OH Primary

Addresses

Primary practice location

987 Boardman Canfield Rd
Boardman, OH 44512-4222

Mailing address

987 Boardman Canfield Rd
Boardman, OH 44512-4222
Phone (330) 965-8760

Other identifiers 1

IdentifierTypeStateIssuer
Z166728OtherAZMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200519001043 OH Practitioner - Dermatology 0042434557 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Mid West Medical College, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optima Dermatology LLCGroup PAC ID 3971561648, 74 clinicians

Practice addresses (Care Compare)

987 Boardman Canfield Rd
Boardman, OH 44512-4222
Phone (330) 965-8760

Hospital & facility affiliations

  • MH St Elizabeth Youngstown Hospital Hospital, Youngstown, OH, CCN 360064

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision88
Removal of skin lesions866
Removal or shaving of skin growth377
Skin biopsy30

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
006424AZMDDermatology Physician
UO2494FLMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Optima Dermatology LLC Dermatology CurrentSince Mar 1, 2020 Accepting new patients

Locations

2525 E State St
Salem, OH 44460
Phone (330) 271-8614

2223 Niles Cortland Rd SE
Warren, OH 44484
Phone (330) 965-8760

1039 Boardman Canfield Rd
Youngstown, OH 44512
Phone (330) 729-2195

987 Boardman Canfield Rd
Youngstown, OH 44512
Phone (330) 271-8589

Interoperability endpoints

  • Direct secure messaging: mbird@advdermatology.emadirect.md

Organizations & group practices 1

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1281657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581984000000",
    "number": "1093020133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "987 BOARDMAN CANFIELD RD",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445124222",
            "telephone_number": "330-965-8760",
            "fax_number": "602-938-9325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "987 BOARDMAN CANFIELD RD",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445124222",
            "telephone_number": "330-965-8760",
            "fax_number": "330-965-9325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BIRD",
        "first_name": "MARIEL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-13",
        "last_updated": "2020-02-18",
        "certification_date": "2020-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AZ",
            "license": "006424",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "UO2494",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OH",
            "license": "34.012984",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "Z166728",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boardman, OH

Sources for this page

Verify at the official NPI Registry.