Bayless Pathmark Inc
Organization Active NPI Anatomic Pathology & Clinical Pathology Physician · Norwalk, OH
NPI 1104015098 · NPPES record last updated Jan 30, 2019
Key facts
- NPI
- 1104015098
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician 207ZP0102X
- Legal business name
- BAYLESS PATHMARK INC
- Practice address
- 272 Benedict Ave
Norwalk, OH 44857 - Phone
- (419) 668-8101
- Fax
- (419) 668-2924
- NPI assigned
- Oct 17, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- BAYLESS PATHMARK INC
Authorized official
- Name
- Dr. Yilan Chang
- Title
- President
- Phone
- (419) 668-8101
Other NPIs on the same Medicare enrollment 9
Practitioners 14
-
Yilan L Chang, MD
-
Zejin Jason Liu, MD
-
Yuchu Sun, MD
-
Elham Kamangar, M.D.
-
Sadia Sultana, M.D.
-
Hai Wang, MD
-
Carlos Nunez, MD
-
Rajeeva R Raju, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031210000010 | OH | Part B Supplier - Clinic/Group Practice | 3577469659 |
Receives reassigned benefits from 9 practitioners 9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Alliance, OH; Bellevue, OH; Middleburg Heights, OH; Norwalk, OH |
National Provider Directory
- Part of
- Pathmark Inc Hillcrest
Locations
6930 Treeline Dr
Ste G
Brecksville, OH 44141
Phone (440) 627-2040
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician |
207ZP0102X | Yes |
Addresses
Primary practice location
272 Benedict Ave
Norwalk, OH 44857
Mailing address
19250 Bagley Rd Ste 101
Middleburg Heights, OH 44130-3348
Phone (440) 826-0384
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0119553 | Medicaid | OH |
Other providers in Norwalk, OH
- Daniel B Barney
- Clyde Glenn Barrett Jr.
- Rachel Renee Basting
- Emily Baumgartner
- Bay Area Digestive Care Inc
- Jeffrey James Becker
- Dell Elaine Bednar
- Madalynn Elizabeth Belinge
- Amber Bentley
- Kelly S Berry
All providers in Norwalk, OH · Anatomic Pathology & Clinical Pathology Physician in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 30, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.