Neogeriatrics

Key facts

NPI

1124259536

Entity type

Organization (NPI type 2)

Primary specialty

Geriatric Medicine (Internal Medicine) Physician 207RG0300X

License

35-083145 (OH)

Legal business name

NEOGERIATRICS

Practice address

4808 Munson St NW
Canton, OH 44718

Phone

(330) 830-8666

Fax

(330) 832-3499

NPI assigned

Aug 3, 2009

Organization subpart

No

Authorized official

Name

Jyothi Dyavanapalli Gudla, MD NPI 1194872713

Title

President

Phone

(330) 830-8666

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Novus Health and Wellness Internal Medicine Physician · Canton, OH · NPI 1841654886
  NPD member Member Of

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jyothi Dyavanapalli Gudla, M.D Geriatric Medicine (Internal Medicine) Physician · Canton, OH · NPI 1194872713
  Medicare reassignment Care Compare group NPD Authorized official GERIATRIC MEDICINE · OH
• Amber Marie Dwan Grassman, RN/BSN Gerontology Nurse Practitioner · Dalton, OH · NPI 1629643242
  Medicare reassignment Care Compare group NPD OH
• Susan C Keter Primary Care Nurse Practitioner · Canton, OH · NPI 1598647067
  Medicare reassignment Care Compare group NPD OH
• Lora Lou Karg, APRN FNP-BC Family Nurse Practitioner · Canton, OH · NPI 1275179129
  NPD

Medicare participation

Medicare fee-for-service enrollment

Enrolled in OH

Medicare enrollment records

National Provider Directory

Locations

Specialties & licenses

Addresses

Other identifiers

Other names

• NOVUS HEALTH AND WELLNESS Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 19, 2024.

{
    "created_epoch": "1249257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731974400000",
    "number": "1124259536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4808 MUNSON ST NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447183613",
            "telephone_number": "330-830-8666",
            "fax_number": "330-832-3499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4808 MUNSON ST NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "44718",
            "telephone_number": "330-830-8666",
            "fax_number": "330-832-3499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEOGERIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-03",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A",
        "authorized_official_last_name": "GUDLA",
        "authorized_official_first_name": "JYOTHI",
        "authorized_official_middle_name": "DYAVANAPALLI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "330-830-8666",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "OH",
            "license": "35-083145",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2940956",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NOVUS HEALTH AND WELLNESS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Canton, OH

• Renee Veronica Nelson
• Tammi Rene' Nelson
• Tara K Nelson
• Joseph L Nemeth III, O.D.
• Kelly Ann Nemetz
• Michelle A Nesbitt, RDH
• Rachel Nesbitt, CRNA
• Netsource Health Services LTD
• Leslie L Neuberger, RN, CNP
• Winifred Mary Neugebauer, LPN

All providers in Canton, OH · Geriatric Medicine (Internal Medicine) Physician in Ohio