Active NPI
Andrew C Pederzolli MD Inc
- Ophthalmology Physician
- Salem, OH
National Provider Identifier
1184697294
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- Legal business name
- ANDREW C PEDERZOLLI MD INC
- Practice address
- 1059 E State St
Salem, OH 44460 - Phone
- (330) 332-9991
- Fax
- (330) 332-2188
- NPI assigned
- Feb 9, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Andrew C Pederzolli, MD
- Title
- Owner
- Phone
- (330) 332-9991
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | Primary |
Addresses
Primary practice location
1059 E State St
Salem, OH 44460
Mailing address
1059 E State St
Salem, OH 44460
Phone (330) 332-9991
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0173771 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071214000289 | OH | Part B Supplier - Clinic/Group Practice | 1850481896 |
Receives reassigned benefits from 2 practitioners 1 other NPI on this enrollment Practice locations: Salem, OH |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 2
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": "1139443200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1284422400000",
"number": "1184697294",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1059 E STATE ST",
"city": "SALEM",
"state": "OH",
"postal_code": "44460",
"telephone_number": "330-332-9991",
"fax_number": "330-332-2188"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1059 E STATE ST",
"city": "SALEM",
"state": "OH",
"postal_code": "44460",
"telephone_number": "330-332-9991",
"fax_number": "330-332-2188"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ANDREW C PEDERZOLLI MD INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-02-09",
"last_updated": "2010-09-14",
"status": "A",
"authorized_official_last_name": "PEDERZOLLI",
"authorized_official_first_name": "ANDREW",
"authorized_official_middle_name": "C",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "330-332-9991",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Ophthalmology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0173771",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salem, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2010; 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.