Gregory J. Mickunas, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

35.076915 Issued in OH

Practice address

90 Jackson Pike
Gallipolis, OH 45631-1560

Phone

(740) 446-5201

Fax

(740) 446-5761

NPI assigned

Jun 2, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 7

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Emergency Medicine

Education

Wright State University Boonshoft School of Medicine, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Marietta Memorial HospitalGroup PAC ID 8224928965, 387 clinicians

Holzer Clinic LLCGroup PAC ID 5890606008, 266 clinicians

Ohio Valley Physicians IncGroup PAC ID 8729032966, 130 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ohiohealth O'Bleness Hospital Hospital, Athens, OH, CCN 360014
• Holzer Medical Center Jackson Hospital, Jackson, OH, CCN 361320
• Marietta Memorial Hospital Hospital, Marietta, OH, CCN 360147
• Holzer Medical Center Hospital, Gallipolis, OH, CCN 360054

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Marietta Memorial Hospital

  • Rural Health Clinic/Center
  • Woodsfield, OH
  • NPI 1962106328
  Medicare reassignment Care Compare group NPD
• Ohio Valley Physicians Inc

  • Family Medicine Physician
  • Huntington, WV
  • NPI 1962433177

  Emergency Medicine, OH

  Medicare reassignment Care Compare group NPD
• Holzer Clinic, LLC

  • Multi-Specialty Clinic/Center
  • Gallipolis, OH
  • NPI 1508817248
  Medicare reassignment Care Compare group
• Emergency Professional Services, Inc.

  • Emergency Medicine Physician
  • Seaman, OH
  • NPI 1093762353
  Medicare reassignment NPD
• Ohio Emergency Professionals Inc

  • Emergency Medicine Physician
  • Columbus, OH
  • NPI 1982983425
  Medicare reassignment NPD
• Selby General Hospital

  • Critical Access Hospital
  • Marietta, OH
  • NPI 1124073465
  Medicare reassignment NPD
• I Path LLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Gallipolis, OH
  • NPI 1942525563
  NPD
• Marietta Memorial Hospital

  • General Acute Care Hospital
  • Marietta, OH
  • NPI 1215936927

  Emergency Medicine

  NPD
• Selby General Hospital

  • Rural Health Clinic/Center
  • Logan, OH
  • NPI 1710840251
  NPD
• Ohio Valley Physicians Inc

  • Rural Health Clinic/Center
  • Eastern, KY
  • NPI 1164129599
  NPD
• Miami Valley Emergency Specialists, LLC

  • Emergency Medicine Physician
  • Dayton, OH
  • NPI 1821189085
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Holzer Hospital Foundation

  • Rural Acute Care Hospital
  • Gallipolis, OH
  • NPI 1942256888
  Care Compare affiliation
• Holzer Medical Center Jackson

  • Critical Access Hospital
  • Jackson, OH
  • NPI 1669410940
  Care Compare affiliation
• Marietta Memorial Hospital

  • General Acute Care Hospital
  • Marietta, OH
  • NPI 1215936927
  Care Compare affiliation
• Sheltering Arms Hospital Foundation, Inc.

  • General Acute Care Hospital
  • Athens, OH
  • NPI 1710913462
  Care Compare affiliation

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708905600000",
    "number": "1225076458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 JACKSON PIKE",
            "city": "GALLIPOLIS",
            "state": "OH",
            "postal_code": "456311560",
            "telephone_number": "740-446-5201",
            "fax_number": "740-446-5761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 JACKSON PIKE",
            "city": "GALLIPOLIS",
            "state": "OH",
            "postal_code": "456311560",
            "telephone_number": "740-446-5201",
            "fax_number": "740-446-5761"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "799 Farson St",
            "address_purpose": "LOCATION",
            "city": "Belpre",
            "state": "OH",
            "postal_code": "457141082",
            "country_code": "US",
            "telephone_number": "740-401-1150",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1106 Colegate Dr",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "OH",
            "postal_code": "457501323",
            "country_code": "US",
            "telephone_number": "740-568-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "206 Columbus Rd",
            "address_purpose": "LOCATION",
            "city": "Athens",
            "state": "OH",
            "postal_code": "457011316",
            "country_code": "US",
            "telephone_number": "740-885-4064",
            "fax_number": "740-885-4027",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MICKUNAS",
        "first_name": "GREGORY",
        "middle_name": "J.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-02",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WV",
            "license": "21326",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "H09359",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "35.076915",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2183131",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "930106929",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISON MEDICAID #",
            "identifier": "000000185284",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOUNTAIN STATE BCBS",
            "identifier": "001714125",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000205913",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3002989000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO MEDICAID CARESOURCE",
            "identifier": "310917085143",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "emergency.providers@mmhs.medicity.net",
            "affiliation": "N",
            "address_1": "799 Farson St",
            "city": "Belpre",
            "state": "OH",
            "country_code": "US",
            "postal_code": "457141082",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "emergency.providers@mmhs.medicity.net",
            "affiliation": "N",
            "address_1": "1106 Colegate Dr",
            "city": "Marietta",
            "state": "OH",
            "country_code": "US",
            "postal_code": "457501323",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "emergency.providers@mmhs.medicity.net",
            "affiliation": "N",
            "address_1": "206 Columbus Rd",
            "city": "Athens",
            "state": "OH",
            "country_code": "US",
            "postal_code": "457011316",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Andrea Danielle Merry-Sperry, D.O.
• Samantha Jo Merry, LMT
• Brenda Jo Mershon, FNP
• Kelly Metzger
• Sarah Meucci
• Austin Lowell Miller
• Crystal Leeann Miller
• Crystal N Miller, RN
• Darian Paige Miller, PA-C
• Earon Miller

• Emergency Medicine Physician in Gallipolis, OH
• Providers in Gallipolis, OH by specialty
• Emergency Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.