Organization Active NPI

Louis Demicco DO Inc.

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Painesville, OH
National Provider Identifier
1174948418
Registry record updated May 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
License
34006748 Issued in OH
Legal business name
LOUIS DEMICCO DO INC.
Practice address
263 Mentor Ave
Painesville, OH 44077-3105
Phone
(440) 354-5643
Fax
(440) 354-5645
NPI assigned
Feb 24, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2014

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

Authorized official

Name
Mrs. Cindy Lee Pruzinsky
Title
Claims Processer
Phone
(440) 354-5643

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 233 OH
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X 34006748 OH Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 012350 OH

Addresses

Primary practice location

263 Mentor Ave
Painesville, OH 44077-3105

Mailing address

263 Mentor Ave
Painesville, OH 44077-3105
Phone (440) 354-5643

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140519000764 OH Part B Supplier - Clinic/Group Practice 5092948760 Receives reassigned benefits from 4 practitioners
Practice locations: Euclid, OH; Painesville, OH

National Provider Directory

National Provider Directory

Locations

25000 Euclid Ave
Ste 302
Euclid, OH 44117
Phone (216) 731-9215

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1393200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400025600000",
    "number": "1174948418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "263 MENTOR AVE",
            "city": "PAINESVILLE",
            "state": "OH",
            "postal_code": "440773105",
            "telephone_number": "440-354-5643",
            "fax_number": "440-354-5645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 MENTOR AVE",
            "city": "PAINESVILLE",
            "state": "OH",
            "postal_code": "440773105",
            "telephone_number": "440-354-5643",
            "fax_number": "440-354-5645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUIS DEMICCO DO INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-24",
        "last_updated": "2014-05-14",
        "status": "A",
        "authorized_official_last_name": "PRUZINSKY",
        "authorized_official_first_name": "CINDY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CLAIMS PROCESSER",
        "authorized_official_telephone_number": "440-354-5643",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "OH",
            "license": "233",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "OH",
            "license": "34006748",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "OH",
            "license": "012350",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Painesville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2014; 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.