NPIMap

Organization Active NPI

East Holmes Family Care Inc

  • Family Medicine Physician
  • Berlin, OH
National Provider Identifier
1164411765
Registry record updated Jul 1, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
EAST HOLMES FAMILY CARE INC
Practice address
4907A Dalbey LN
Berlin, OH 44610
Phone
(330) 893-3771
Fax
(330) 893-3770
NPI assigned
Oct 17, 2005
Last updated
Jul 1, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2014

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

Authorized official

Name
Dr. Robert Kim Kornhaus, M.D.
Title
Physician
Phone
(330) 893-3771

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

4907A Dalbey LN
Berlin, OH 44610

Mailing address

PO Box 366
Berlin, OH 44610
Phone (330) 893-3771

Other identifiers 1

IdentifierTypeStateIssuer
0851369MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040712000818 OH Part B Supplier - Clinic/Group Practice 4587642947 Receives reassigned benefits from 6 practitioners
3 other NPIs on this enrollment
Practice locations: Baltic, OH; Berlin, OH; Walnut Creek, OH

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D0901052East Holmes Family Care, Inc4907A Dalbey LN, Berlin, OH 44610Certificate of waiverMar 31, 2027

National Provider Directory

National Provider Directory
Tax ID family
East Holmes Family Care Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1129507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404172800000",
    "number": "1164411765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 366",
            "city": "BERLIN",
            "state": "OH",
            "postal_code": "44610",
            "telephone_number": "330-893-3771",
            "fax_number": "330-893-3770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4907A DALBEY LN",
            "city": "BERLIN",
            "state": "OH",
            "postal_code": "44610",
            "telephone_number": "330-893-3771",
            "fax_number": "330-893-3770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST HOLMES FAMILY CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-17",
        "last_updated": "2014-07-01",
        "status": "A",
        "authorized_official_last_name": "KORNHAUS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "KIM",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "330-893-3771",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0851369",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berlin, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.