Organization Active NPI

Clinicians in Infectious Diseases,Inc

  • Infectious Disease Physician
  • Canton, OH
National Provider Identifier
1457554842
Registry record updated Dec 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
Legal business name
CLINICIANS IN INFECTIOUS DISEASES,INC
Practice address
128 Wertz Ave NW
Canton, OH 44708-4196
Phone
(330) 454-7722
Fax
(330) 454-7834
NPI assigned
Jun 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2024

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

Authorized official

Name
Joan Ellen Flickinger
Title
Authorized Official
Phone
(330) 454-7722

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 34071905 OH
Infectious Disease Physician 207RI0200X Primary

Addresses

Primary practice location

128 Wertz Ave NW
Canton, OH 44708-4196

Mailing address

128 Wertz Ave NW
Canton, OH 44708-4196
Phone (330) 454-7722

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071115000690 OH Part B Supplier - Clinic/Group Practice 2466540901 Receives reassigned benefits from 3 practitioners
Practice locations: Canton, OH

National Provider Directory

National Provider Directory

Locations

128 Wertz Ave NW
Ste C
Canton, OH 44708
Phone (330) 454-7722

128 Wertz Ave NW
Canton, OH 44708
Phone (330) 454-7722

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734048000000",
    "number": "1457554842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 WERTZ AVE NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447084196",
            "telephone_number": "330-454-7722",
            "fax_number": "330-454-7834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 WERTZ AVE NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447084196",
            "telephone_number": "330-454-7722",
            "fax_number": "330-454-7834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICIANS IN INFECTIOUS DISEASES,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-06",
        "last_updated": "2024-12-13",
        "certification_date": "2024-12-13",
        "status": "A",
        "authorized_official_last_name": "FLICKINGER",
        "authorized_official_first_name": "JOAN",
        "authorized_official_middle_name": "ELLEN",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "330-454-7722"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "OH",
            "license": "34071905",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 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.