Individual provider Active NPI

Joanne M Vaccani, CNS

  • Adult Psychiatric/Mental Health Clinical Nurse Specialist
  • Canton, OH
National Provider Identifier
1255418968
Registry record updated Apr 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Psychiatric/Mental Health Clinical Nurse SpecialistTaxonomy code 364SP0809X
License
COA.02622-NS Issued in OH
Practice address
624 Market Ave N
Canton, OH 44702-1017
Phone
(330) 493-4553
Fax
(330) 493-3761
NPI assigned
Nov 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2020

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Psychiatric/Mental Health Clinical Nurse Specialist 364SP0809X COA.02622-NS OH Primary
Registered Nurse 163W00000X NS02622 OH
Registered Nurse 163W00000X 070153-1 OH
Adult Psychiatric/Mental Health Registered Nurse 163WP0809X 242355-01 OH
Adult Psychiatric/Mental Health Registered Nurse 163WP0809X CTP02622RX OH
Adult Psychiatric/Mental Health Clinical Nurse Specialist 364SP0809X RX-02622 OH

Addresses

Primary practice location

624 Market Ave N
Canton, OH 44702-1017

Mailing address

624 Market Ave N
Canton, OH 44702-1017
Phone (330) 833-5530

Other identifiers 1

IdentifierTypeStateIssuer
3102690MedicaidOH

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100928001059 OH Practitioner - Certified Clinical Nurse Specialist (CNS) 1951427897 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Clinical Nurse Specialist (CNS)
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

4735 Beldar St NW
Canton, OH 44718-3648
Phone (330) 493-9822

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Specialist

State licenses

LicenseStateTypeSpecialty
070153-1OHMDRegistered Nurse
NS02622OHMDRegistered Nurse
242355-01OHMDAdult Psychiatric/Mental Health Registered Nurse
CTP02622RXOHMDAdult Psychiatric/Mental Health Registered Nurse
COA.02622-NSOHMDAdult Psychiatric/Mental Health Clinical Nurse Specialist
RX-02622OHMDAdult Psychiatric/Mental Health Clinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Phoenix Rising Behavioral Healthcare and Recovery Inc CurrentSince Feb 1, 2011 Accepting new patients
New Horizons Psychiatric Counseling and Pain Management Services LLC CurrentSince Jan 12, 2020 Accepting new patients
Phoenix Rising Behavioral Healthcare and Recovery, Inc CurrentSince Feb 1, 2011 Accepting new patients
Aultman Hospital Past Accepting new patients

Locations

4735 Belpar St NW
Canton, OH 44718
Phone (330) 417-9552

624 Market Ave N
Canton, OH 44702
Phone (330) 454-7066

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586390400000",
    "number": "1255418968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 MARKET AVE N",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447021017",
            "telephone_number": "330-833-5530",
            "fax_number": "330-833-6085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 MARKET AVE N",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447021017",
            "telephone_number": "330-493-4553",
            "fax_number": "330-493-3761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VACCANI",
        "first_name": "JOANNE",
        "middle_name": "M",
        "credential": "CNS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-04-09",
        "certification_date": "2020-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SP0809X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Adult",
            "state": "OH",
            "license": "COA.02622-NS",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "NS02622",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "070153-1",
            "primary": false
        },
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "OH",
            "license": "242355-01",
            "primary": false
        },
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "OH",
            "license": "CTP02622RX",
            "primary": false
        },
        {
            "code": "364SP0809X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Adult",
            "state": "OH",
            "license": "RX-02622",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3102690",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, OH

Sources for this page

Verify at the official NPI Registry.