NPIMap

Individual provider Active NPI

Mark James Colaluca, CNP

  • Primary Care Nurse Practitioner
  • Boardman, OH
National Provider Identifier
1467091751
Registry record updated Oct 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
APRN.CNP.025827 Issued in OH
Practice address
835 McKay CT Ste 100
Boardman, OH 44512-5786
Phone
(330) 758-4399
Fax
(330) 758-8995
NPI assigned
Jan 3, 2020
Last updated
Oct 10, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X APRN.CNP.025827 OH
Gerontology Nurse Practitioner 363LG0600X APRN.CNP.025827 OH
Primary Care Nurse Practitioner 363LP2300X APRN.CNP.025827 OH Primary

Addresses

Primary practice location

835 McKay CT Ste 100
Boardman, OH 44512-5786

Mailing address

835 McKay CT Ste 100
Boardman, OH 44512-5786
Phone (330) 758-4399

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200220003020 OH Practitioner - Nurse Practitioner 7618304254 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians

Practice addresses (Care Compare)

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

8423 Market St
Suite 207
Boardman, OH 44512-6778
Phone (330) 729-7901

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN.CNP.025827OHMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Physicians Youngstown, LLC CurrentSince Mar 2, 2020 Accepting new patients
Mercy Health Physicians Youngstown Specialty Care LLC CurrentSince Jan 1, 2022 Accepting new patients
Mercy Health Physicians Youngstown Specialty Care LLC CurrentSince Jan 1, 2022 Accepting new patients
Mercy Health Physicians Youngstown LLC CurrentSince Mar 2, 2020 Accepting new patients

Locations

107 Royal Birkdale Dr
Ste A
Columbiana, OH 44408
Phone (330) 482-9350

410 W 10th Ave
Columbus, OH 43210
Phone (614) 293-5905

1044 Belmont Ave
Youngstown, OH 44504
Phone (330) 480-2182

835 McKay Ct
Ste 100
Youngstown, OH 44512
Phone (330) 758-4399

8423 Market St
Ste 207
Youngstown, OH 44512
Phone (330) 729-7901

Interoperability endpoints

  • Direct secure messaging: mcolaluca37348@direct.bsmhealth.org

Organizations & group practices 4

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 3

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": "1578009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728518400000",
    "number": "1467091751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "835 MCKAY CT STE 100",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445125786",
            "telephone_number": "330-758-4399",
            "fax_number": "330-758-8995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 MCKAY CT STE 100",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445125786",
            "telephone_number": "330-758-4399",
            "fax_number": "330-758-8995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLALUCA",
        "first_name": "MARK",
        "middle_name": "JAMES",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-01-03",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OH",
            "license": "APRN.CNP.025827",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "OH",
            "license": "APRN.CNP.025827",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "OH",
            "license": "APRN.CNP.025827",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boardman, OH

Sources for this page

Verify at the official NPI Registry.