Individual provider Active NPI

Autumn Campbell, PA-C

  • Physician Assistant
  • Canton, OH
National Provider Identifier
1396110656
Registry record updated Dec 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
004534 Issued in OH
Practice address
4634 Hills and Dales Rd NW
Canton, OH 44708-1510
Phone
(330) 477-0255
Fax
(330) 479-0392
NPI assigned
Dec 11, 2015
Last updated
Dec 11, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 004534 OH Primary

Addresses

Primary practice location

4634 Hills and Dales Rd NW
Canton, OH 44708-1510

Mailing address

4634 Hills and Dales Rd NW
Canton, OH 44708-1510
Phone (330) 477-0255

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
I20160310001271 OH Practitioner - Physician Assistant 8729384193 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ohio Physician Professional CorporationGroup PAC ID 2668406059, 143 clinicians

Practice addresses (Care Compare)

2600 6TH St SW
Canton, OH 44710-1702
Phone (330) 454-8076

2600 6TH SWST
Canton, OH 44710-1702
Phone (330) 363-1342

2600 W 6TH St
Canton, OH 44710-1702

4634 Hills and Dales Rd NW
Canton, OH 44708-1510
Phone (330) 477-0255

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
004534OHMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: autumnc@neoe.medentdirect.com

Organizations & group practices 1

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.

Hospital & facility affiliations 5

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": "1449792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449792000000",
    "number": "1396110656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4634 HILLS AND DALES RD NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447081510",
            "telephone_number": "330-477-0255",
            "fax_number": "330-479-0392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4634 HILLS AND DALES RD NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447081510",
            "telephone_number": "330-477-0255",
            "fax_number": "330-479-0392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "AUTUMN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-11",
        "last_updated": "2015-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "004534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, OH

Sources for this page

Verify at the official NPI Registry.