NPIMap

Individual provider Active NPI

Anthony Innocenzi, DPM

  • Podiatrist
  • Canfield, OH
National Provider Identifier
1255336079
Registry record updated Aug 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
36-00-3012-I Issued in OH
Practice address
6715 Tippecanoe Rd
Building F Unit 101
Canfield, OH 44406-8180
Phone
(330) 702-0978
NPI assigned
Jun 17, 2005
Last updated
Aug 27, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 36-00-3012-I OH Primary

Addresses

Primary practice location

6715 Tippecanoe Rd
Building F Unit 101
Canfield, OH 44406-8180

Mailing address

6715 Tippecanoe Rd
Building F Unit 101
Canfield, OH 44406-8180
Phone (330) 702-0978

Other identifiers 2

IdentifierTypeStateIssuer
2046191MedicaidOH
0018292210001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
367KSMDSpeech-Language Pathologist
331NMMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Senior Healthservices Inc Podiatrist Past Accepting new patients
Brian M Elias DPM PC Podiatrist Past Accepting new patients
Anthony E Innocenzi DPM Inc Podiatrist PastSince Dec 12, 2000 Accepting new patients
Jla Senior Footcare Ms LLC PastSince Jan 8, 2011 Accepting new patients

Organizations & group practices 10

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

NPI Registry JSON

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

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282867200000",
    "number": "1255336079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6715 TIPPECANOE RD",
            "address_2": "BUILDING F UNIT 101",
            "city": "CANFIELD",
            "state": "OH",
            "postal_code": "444068180",
            "telephone_number": "330-702-0978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6715 TIPPECANOE RD",
            "address_2": "BUILDING F UNIT 101",
            "city": "CANFIELD",
            "state": "OH",
            "postal_code": "444068180",
            "telephone_number": "330-702-0978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INNOCENZI",
        "first_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-17",
        "last_updated": "2010-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "OH",
            "license": "36-00-3012-I",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2046191",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018292210001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canfield, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.