Individual provider Active NPI

Jessica Angelo, PA-C

  • Physician Assistant
  • Avon, OH
National Provider Identifier
1104292788
Registry record updated Nov 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
004377 Issued in OH
Practice address
33100 Cleveland Clinic Blvd
Avon, OH 44011-1390
Phone
(440) 695-4145
Fax
(440) 695-4219
NPI assigned
Aug 18, 2015
Last updated
Nov 13, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 004377 OH Primary

Addresses

Primary practice location

33100 Cleveland Clinic Blvd
Avon, OH 44011-1390

Mailing address

33100 Cleveland Clinic Blvd
Avon, OH 44011-1390
Phone (440) 695-4145

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150918002374 OH Practitioner - Physician Assistant 1052628369 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Cleveland ClinicGroup PAC ID 1850203555, 6,954 clinicians

Practice addresses (Care Compare)

33300 Cleveland Clinic Blvd
Avon, OH 44011-1172
Phone (440) 695-5000

5334 Meador Lane CT
Sheffield Village, OH 44035-1469

8950 Euclid Ave
Cleveland, OH 44195-0001
Phone (216) 444-8950

9500 Euclid Ave
Cleveland, OH 44195-0001

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
004377OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Cleveland Clinic Foundation CurrentSince Aug 9, 2015 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

33100 Cleveland Clinic Blvd
Avon, OH 44011
Phone (440) 695-4000

33300 Cleveland Clinic Blvd
Avon, OH 44011
Phone (440) 695-4000

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1439856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510531200000",
    "number": "1104292788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33100 CLEVELAND CLINIC BLVD",
            "city": "AVON",
            "state": "OH",
            "postal_code": "440111390",
            "telephone_number": "440-695-4145",
            "fax_number": "440-695-4219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33100 CLEVELAND CLINIC BLVD",
            "city": "AVON",
            "state": "OH",
            "postal_code": "440111390",
            "telephone_number": "440-695-4145",
            "fax_number": "440-695-4219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANGELO",
        "first_name": "JESSICA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-18",
        "last_updated": "2017-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "004377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Avon, OH

Sources for this page

Verify at the official NPI Registry.