Individual provider Active NPI

Douglas Carlisle Fleck, MD

  • Pediatrics Physician
  • Ashtabula, OH
National Provider Identifier
1124081427
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
35085846 Issued in OH
Practice address
3315 N Ridge Rd E Ste 100
Ashtabula, OH 44004-4347
Phone
(440) 964-8387
NPI assigned
Apr 8, 2006
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 35085846 OH Primary

Addresses

Primary practice location

3315 N Ridge Rd E Ste 100
Ashtabula, OH 44004-4347

Mailing address

3315 N Ridge Rd E Ste 100
Ashtabula, OH 44004-4347

Other practice location 1

2054 South Green Road
South Euclid, OH 44121
Phone (216) 291-9210

Other practice location 2

2054 South Green Road
South Euclid, OH 44121
Phone (216) 291-9210

Other identifiers 1

IdentifierTypeStateIssuer
2578492MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35085846OHMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Shelly David Senders, MD, Inc Pediatrics PastSince Jul 15, 2021 Accepting new patients
University Primary Care Practices Pediatrics Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: dfleck37818@ehrdirect.uhhospitals.org

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.

NPI Registry JSON

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

{
    "created_epoch": "1144454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1124081427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3315 N RIDGE RD E STE 100",
            "city": "ASHTABULA",
            "state": "OH",
            "postal_code": "440044347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3315 N RIDGE RD E STE 100",
            "city": "ASHTABULA",
            "state": "OH",
            "postal_code": "440044347",
            "telephone_number": "440-964-8387"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2054 South Green Road",
            "address_purpose": "LOCATION",
            "city": "South Euclid",
            "state": "OH",
            "postal_code": "44121",
            "country_code": "US",
            "telephone_number": "216-291-9210",
            "fax_number": "216-291-9422",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2054 South Green Road",
            "address_purpose": "LOCATION",
            "city": "South Euclid",
            "state": "OH",
            "postal_code": "44121",
            "country_code": "US",
            "telephone_number": "216-291-9210",
            "fax_number": "216-291-9422",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FLECK",
        "first_name": "DOUGLAS",
        "middle_name": "CARLISLE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-08",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35085846",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2578492",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ashtabula, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.