NPIMap

Organization Active NPI

Emergency Medicine Physicians of Lake County LTD

  • Emergency Medicine Physician
  • Willoughby, OH
National Provider Identifier
1154763944
Registry record updated Jul 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
EMERGENCY MEDICINE PHYSICIANS OF LAKE COUNTY LTD
Practice address
36000 Euclid Ave
Willoughby, OH 44094-4625
Phone
(330) 493-4443
Fax
(330) 493-8677
NPI assigned
Jul 23, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2013

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

Authorized official

Name
David Charles Packo, MD
Title
President
Phone
(330) 493-4443

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

36000 Euclid Ave
Willoughby, OH 44094-4625

Mailing address

4535 Dressler Rd NW
Canton, OH 44718-2545
Phone (330) 493-4443

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131007000784 OH Part B Supplier - Clinic/Group Practice 0042444051 Receives reassigned benefits from 104 practitioners
Practice locations: Concord TWP, OH; Willoughby, OH

National Provider Directory

National Provider Directory

Locations

6270 N Ridge Rd
Madison, OH 44057
Phone (440) 428-8292

Practitioners & affiliated clinicians

Practitioners 104

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

View all 104

NPI Registry JSON

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

{
    "created_epoch": "1374537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374537600000",
    "number": "1154763944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4535 DRESSLER RD NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182545",
            "telephone_number": "330-493-4443",
            "fax_number": "330-451-4142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36000 EUCLID AVE",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440944625",
            "telephone_number": "330-493-4443",
            "fax_number": "330-493-8677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERGENCY MEDICINE PHYSICIANS OF LAKE COUNTY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-23",
        "last_updated": "2013-07-23",
        "status": "A",
        "authorized_official_last_name": "PACKO",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "330-493-4443",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willoughby, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.