Individual provider Active NPI

Kristin R Homoki, PA-C

  • Physician Assistant
  • Cleveland, OH
National Provider Identifier
1467664391
Registry record updated Nov 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.003161 Issued in OH
Practice address
9500 Euclid Ave
Cleveland, OH 44195-4021
Phone
(216) 445-3765
NPI assigned
May 4, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 19, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X AT1199 OH
Physician Assistant 363A00000X 50.003161 OH Primary

Addresses

Primary practice location

9500 Euclid Ave
Cleveland, OH 44195-4021

Mailing address

427 University Ave
Elyria, OH 44035-7155
Phone (440) 865-4729

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101207000719 OH Practitioner - Physician Assistant 5799972477 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cleveland Clinic Health System - East RegionGroup PAC ID 2264337955, 97 clinicians

Practice addresses (Care Compare)

18901 Lake Shore Blvd
Euclid, OH 44119-1078
Phone (216) 531-9000

6780 Mayfield Rd
Mayfield Heights, OH 44124-2203
Phone (440) 449-4500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
AT1199OHMDAthletic Trainer
50.003161OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cleveland Clinic Health System - East Region CurrentSince Jan 1, 2018 Accepting new patients
The Cleveland Clinic Foundation CurrentSince Oct 27, 2010 Accepting new patients
Wooster Clinic, LLC CurrentSince Aug 7, 2017 Accepting new patients
Cleveland Clinic Health System - East Region CurrentSince Jan 1, 2018 Accepting new patients

Locations

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270

18901 Lake Shore Blvd
Euclid, OH 44119
Phone (216) 531-9000

6780 Mayfield Rd
Mayfield Hts, OH 44124
Phone (440) 331-9520

6801 Brecksville Rd
Ste 20
Seven Hills, OH 44131
Phone (216) 445-3363

1740 Cleveland Rd
Wooster, OH 44691
Phone (330) 287-4500

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290124800000",
    "number": "1467664391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "427 UNIVERSITY AVE",
            "city": "ELYRIA",
            "state": "OH",
            "postal_code": "440357155",
            "telephone_number": "440-865-4729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 EUCLID AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441954021",
            "telephone_number": "216-445-3765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOMOKI",
        "first_name": "KRISTIN",
        "middle_name": "R",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-04",
        "last_updated": "2010-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "OH",
            "license": "AT1199",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.003161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.