Individual provider Active NPI

Anthony Haeufgloeckner, DO

  • Family Medicine Physician
  • Canton, OH
National Provider Identifier
1285667782
Registry record updated Mar 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
34008117 Issued in OH
Practice address
4320 Cleveland Ave SE
Canton, OH 44707-1143
Phone
(330) 484-2584
Fax
(330) 484-3529
NPI assigned
Jul 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 34008117 OH Primary

Addresses

Primary practice location

4320 Cleveland Ave SE
Canton, OH 44707-1143

Mailing address

4320 Cleveland Ave SE
Canton, OH 44707-1143
Phone (330) 484-2584

Other identifiers 2

IdentifierTypeStateIssuer
2566567MedicaidOH
34008117OtherOHLICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ANTHONY.HAEUFGLOECKNER@DIRECT.AULTMAN.ORG Direct

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050623000000 OH Practitioner - Family Practice 6901841675 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aultman North Canton Medical GroupGroup PAC ID 4082605266, 48 clinicians

Practice addresses (Care Compare)

2600 6TH St SW
Canton, OH 44710-1702
Phone (330) 438-6333

4320 Cleveland Ave S
Canton, OH 44707-1143
Phone (330) 484-2584

Hospital & facility affiliations

  • Aultman Health Care in Your Home Home health agency, Canton, OH, CCN 367290
  • Aultman Hospital Hospital, Canton, OH, CCN 360084
  • Alliance Community Hospital Hospital, Alliance, OH, CCN 360131

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
34008117OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aultman North Canton Medical Group CurrentSince Mar 1, 2010 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
North Canton Medical Foundation Past Accepting new patients

Locations

10724 State Route 212 NE
Bolivar, OH 44612
Phone (330) 874-7165

2600 6th St SW
Canton, OH 44710
Phone (330) 363-2180

4320 Cleveland Ave S
Canton, OH 44707
Phone (330) 484-2584

6046 Whipple Ave NW
North Canton, OH 44720
Phone (330) 433-1200

Interoperability endpoints

  • Direct secure messaging: anthony.haeufgloeckner@direct.aultman.org

Organizations & group practices 3

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646611200000",
    "number": "1285667782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4320 CLEVELAND AVE SE",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447071143",
            "telephone_number": "330-484-2584",
            "fax_number": "330-484-3529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4320 CLEVELAND AVE SE",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447071143",
            "telephone_number": "330-484-2584",
            "fax_number": "330-484-3529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAEUFGLOECKNER",
        "first_name": "ANTHONY",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-08",
        "last_updated": "2022-03-07",
        "certification_date": "2022-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "34008117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2566567",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "34008117",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ANTHONY.HAEUFGLOECKNER@DIRECT.AULTMAN.ORG",
            "affiliation": "N",
            "endpointDescription": "Direct Email via Employer",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4320 Cleveland Ave SE",
            "city": "Canton",
            "state": "OH",
            "country_code": "US",
            "postal_code": "447071143",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Canton, OH

Sources for this page

Verify at the official NPI Registry.