Stark County Medical Group, Inc.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

01397525 Issued in OH

Legal business name

STARK COUNTY MEDICAL GROUP, INC.

Practice address

4810 Munson St NW
Canton, OH 44718-3613

Phone

(330) 499-3377

NPI assigned

Aug 9, 2006

Organization subpart

No

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

Authorized official

Name

Carrie Lynn Gillson

Title

Office Manager

Phone

(330) 499-3377

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Tax ID family

Stark County Medical Group Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Stark County Medical Group, Inc.

  • Legal Medicine
  • Canton, OH
  • NPI 1174610398
  NPD tax ID

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stacey Hollaway, MD

  • Internal Medicine Physician
  • Canton, OH
  • NPI 1922064906
  Medicare reassignment Care Compare group NPD
• Barbara H Volk

  • Internal Medicine Physician
  • Canton, OH
  • NPI 1376509877
  Medicare reassignment Care Compare group NPD
• Donna J Backus, MD

  • Pediatrics Physician
  • Akron, OH
  • NPI 1831132901
  NPD (past)

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706486400000",
    "number": "1427068634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4810 MUNSON ST NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447183613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4810 MUNSON ST NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447183613",
            "telephone_number": "330-499-3377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STARK COUNTY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-09",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-29",
        "status": "A",
        "authorized_official_last_name": "GILLSON",
        "authorized_official_first_name": "CARRIE",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "330-499-3377"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "01397525",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "01397525",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stark County Edcuational Service Center
• Stark County Emergency Physicians
• Stark County Emergency Physicians, Inc
• Stark County Foot & Ankle Clinic
• Stark County Medical Group, Inc.
• Stark County Pathologists Inc
• Stark County Physicians LLC
• Stark County Tasc
• Stark County Tasc, Inc.
• Stark County Urban Minority Alcohol and Drug Addiction Outreach Proje

• Internal Medicine Physician in Canton, OH
• Providers in Canton, OH by specialty
• Internal Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.