NPIMap

Organization Active NPI

Poland Medical Center LTD

  • Family Medicine Physician
  • Poland, OH
National Provider Identifier
1346338142
Registry record updated Mar 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
POLAND MEDICAL CENTER LTD
Practice address
6615 Clingan Road
Poland, OH 44514-4202
Phone
(330) 707-1425
Fax
(330) 757-2814
NPI assigned
Oct 10, 2006
Last updated
Mar 16, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2023

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

Authorized official

Name
Dr. Michael B Evan, MDNPI 1336123124
Title
President
Phone
(330) 707-1425

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

6615 Clingan Road
Poland, OH 44514-4202

Mailing address

6615 Clingan Road
Poland, OH 44514-4202
Phone (330) 707-1425

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20061205000006 OH Part B Supplier - Clinic/Group Practice 3678572559 Receives reassigned benefits from 11 practitioners
Practice locations: Poland, OH
O20100930012258 OH DME Supplier - Physician - Family Practice 3678572559 Practice locations: Poland, OH

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D0669289Poland Medical Center6615 Clingan Road Suite a, Poland, OH 44514Certificate of waiverDec 22, 2027
36D0720794Poland Medical Center6615 Clingan Road, Suite C, Poland, OH 44514Certificate of waiverDec 27, 2026

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

6615 Clingan Rd
Poland, OH 44514
Phone (330) 757-3643

6615 Clingan Rd
Ste C
Youngstown, OH 44514
Phone (330) 757-7888

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678924800000",
    "number": "1346338142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6615 CLINGAN ROAD",
            "city": "POLAND",
            "state": "OH",
            "postal_code": "445144202",
            "telephone_number": "330-707-1425",
            "fax_number": "330-757-2814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6615 CLINGAN ROAD",
            "city": "POLAND",
            "state": "OH",
            "postal_code": "445144202",
            "telephone_number": "330-707-1425",
            "fax_number": "330-757-2814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLAND MEDICAL CENTER LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A",
        "authorized_official_last_name": "EVAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "330-707-1425",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Poland, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.