Individual provider Active NPI

Pooja Vallatharasan

  • Student in an Organized Health Care Education/Training Program
  • Boardman, OH
National Provider Identifier
1114721917
Registry record updated Jun 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
8423 Market St Ste 101
Boardman, OH 44512-6778
Phone
(330) 729-8700
Fax
(330) 729-8701
NPI assigned
Apr 2, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 30, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training ProgramGroup: 193400000X SINGLE SPECIALTY GROUP 390200000X Primary

Addresses

Primary practice location

8423 Market St Ste 101
Boardman, OH 44512-6778

Mailing address

8423 Market St Ste 101
Boardman, OH 44512-6778
Phone (330) 729-8700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20250710002975 TX Order and Referring Only - Family PracticePractitioner - Family Practice 4385158229

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Physicians Youngstown LLC Past Accepting new patients
Mercy Health Physicians Youngstown, LLC Single Specialty Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1743552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782777600000",
    "number": "1114721917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8423 MARKET ST STE 101",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445126778",
            "telephone_number": "330-729-8700",
            "fax_number": "330-729-8701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8423 MARKET ST STE 101",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445126778",
            "telephone_number": "330-729-8700",
            "fax_number": "330-729-8701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALLATHARASAN",
        "first_name": "POOJA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-04-02",
        "last_updated": "2026-06-30",
        "certification_date": "2026-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boardman, OH

Sources for this page

Verify at the official NPI Registry.