Active NPI
John C Pedersen, M.D.
- Plastic Surgery Physician
- Fairlawn, OH
National Provider Identifier
1396723409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- 35--070058
- Practice address
- 270 S Cleveland Massillon Rd Ste C
Fairlawn, OH 44333-6000 - Phone
- (330) 443-0221
- Fax
- (330) 303-1880
- NPI assigned
- Jan 9, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | 35--070058 | OH | Primary |
Addresses
Primary practice location
270 S Cleveland Massillon Rd Ste C
Fairlawn, OH 44333-6000
Mailing address
270 S Cleveland Massillon Rd Ste C
Fairlawn, OH 44333-6000
Phone (330) 443-0221
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0435666 | Medicaid | OH | |
| 1942892237 | Other | OH | NPI2 |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35--070058 | OH | MD | Plastic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Euclid Hospital Cleveland Clinic Health System | Current | Accepting new patients | |
| Wound Care Associates of Akron, Inc | Past | Accepting new patients |
Interoperability endpoints
- jpedersen389914@direct.ccf.org
Organizations & group practices 2
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.
-
- General Acute Care Hospital
- Euclid, OH
- NPI 1457403016
-
- Orthopaedic Surgery Physician
- Akron, OH
- NPI 1184684771
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136764800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634515200000",
"number": "1396723409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "270 S CLEVELAND MASSILLON RD STE C",
"city": "FAIRLAWN",
"state": "OH",
"postal_code": "443336000",
"telephone_number": "330-443-0221",
"fax_number": "330-303-1880"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "270 S CLEVELAND MASSILLON RD STE C",
"city": "FAIRLAWN",
"state": "OH",
"postal_code": "443336000",
"telephone_number": "330-443-0221",
"fax_number": "330-303-1880"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDERSEN",
"first_name": "JOHN",
"middle_name": "C",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-09",
"last_updated": "2021-10-18",
"certification_date": "2021-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "OH",
"license": "35--070058",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0435666",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI2",
"identifier": "1942892237",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairlawn, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.