Individual provider Active NPI

Jennifer Marie Pamfilie, M.D.

  • Family Medicine Physician
  • Hudson, OH
National Provider Identifier
1104817212
Registry record updated Jan 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35-071229 Issued in OH
Practice address
5655 Hudson Dr Ste 303
Hudson, OH 44236-4454
Phone
(330) 800-4800
Fax
(330) 653-3016
NPI assigned
Oct 31, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35071229P OH
Family Medicine Physician 207Q00000X 35-071229 OH Primary

Addresses

Primary practice location

5655 Hudson Dr Ste 303
Hudson, OH 44236-4454

Mailing address

5655 Hudson Dr Ste 303
Hudson, OH 44236-4454
Phone (330) 800-4800

Other identifiers 4

IdentifierTypeStateIssuer
Q005440OtherOHHOMETOWN
2110585MedicaidOH
5718736OtherAETNA
604OtherOHSUMMACARE

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
I20060105000408 OH Practitioner - Family Practice 0648293688 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Northeastern Ohio University College of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hudson Family Practice, IncGroup PAC ID 8527113950, 2 clinicians

Practice addresses (Care Compare)

5655 Hudson Dr
Suite 303
Hudson, OH 44236-4454
Phone (330) 800-4800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35-071229OHMDFamily Medicine Physician
35071229POHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hudson Family Practice, Inc Family Medicine CurrentSince Aug 1, 2020 Accepting new patients

Locations

5655 Hudson Dr
Ste 303
Hudson, OH 44236
Phone (330) 800-4800

4302 Allen Rd
Ste 400
Stow, OH 44224
Phone (330) 344-3000

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IEEFBA/Endpoint/IEEFBA

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 6

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": "1130716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611532800000",
    "number": "1104817212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5655 HUDSON DR STE 303",
            "city": "HUDSON",
            "state": "OH",
            "postal_code": "442364454",
            "telephone_number": "330-800-4800",
            "fax_number": "330-653-3016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5655 HUDSON DR STE 303",
            "city": "HUDSON",
            "state": "OH",
            "postal_code": "442364454",
            "telephone_number": "330-800-4800",
            "fax_number": "330-653-3016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAMFILIE",
        "first_name": "JENNIFER",
        "middle_name": "MARIE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-31",
        "last_updated": "2021-01-25",
        "certification_date": "2021-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35071229P",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35-071229",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOMETOWN",
            "identifier": "Q005440",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2110585",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5718736",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUMMACARE",
            "identifier": "604",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hudson, OH

Sources for this page

Verify at the official NPI Registry.