Debora Petani, PA-C
Individual provider Active NPI Physician Assistant · Elyria, OH
NPI 1467083501 · NPPES record last updated Jan 28, 2020
Key facts
- NPI
- 1467083501
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 50.006079 (OH)
- Practice address
- 630 E River St
Elyria, OH 44035-5902 - Phone
- (440) 329-7500
- NPI assigned
- Jan 28, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Cleveland Clinic Avon Hospital
Practice addresses (Care Compare)
33300 Cleveland Clinic Blvd
Avon, OH 44011-1172
Phone (440) 695-5000
33300 Cleveland Clinic Blvd
Avon, OH 44011-1390
Phone (440) 695-5000
Hospital & facility affiliations
- Cleveland Clinic Avon Hospital
- Cleveland Clinic
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200406002134 | OH | Practitioner - Physician Assistant | 4587093943 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50.006079 | OH | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emh Regional Medical Center | Physician Assistant | Current |
Accepting new patients |
Locations
630 E River St
Elyria, OH 44035
Phone (440) 329-7450
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 50.006079 | OH | Yes |
Addresses
Primary practice location
630 E River St
Elyria, OH 44035-5902
Mailing address
1425 Elbur Ave
Lakewood, OH 44107-4727
Phone (216) 703-0140
Other providers in Elyria, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.