Active NPI
Kathleen M Fagan, MD
- Preventive Medicine/Occupational Environmental Medicine Physician
- Cleveland, OH
National Provider Identifier
1528005543
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Preventive Medicine/Occupational Environmental Medicine Physician
- License
- 35051175
- Practice address
- 11100 Euclid Avenue
Cleveland, OH 44106 - Phone
- (216) 844-7700
- Fax
- (216) 286-6299
- NPI assigned
- May 31, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Preventive Medicine/Occupational Environmental Medicine Physician | 2083P0500X | 35051175 | OH | Primary |
Addresses
Primary practice location
11100 Euclid Avenue
Cleveland, OH 44106
Mailing address
3605 Warrensville Ctr Rd
Msc9152
Shaker HTS, OH 44122
Phone (216) 286-6299
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0607641 | Medicaid | OH | |
| 000000221255 | Other | OH | UNISON |
| 4052254 | Other | OH | AETNA |
| 000000525944 | Other | OH | ANTHEM |
| 363514 | Other | OH | WELLCARE |
| 0607641 | Other | OH | BCMH |
| 745904 | Other | OH | BUCKEYE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Health-Regional Medical Center LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Retail Pharmacy
- Lorain, OH
- NPI 1942718713
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213228800000",
"number": "1528005543",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3605 WARRENSVILLE CTR RD",
"address_2": "MSC9152",
"city": "SHAKER HTS",
"state": "OH",
"postal_code": "44122",
"telephone_number": "216-286-6299",
"fax_number": "216-286-6341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11100 EUCLID AVENUE",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "44106",
"telephone_number": "216-844-7700",
"fax_number": "216-286-6299"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAGAN",
"first_name": "KATHLEEN",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-05-31",
"last_updated": "2008-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "2083P0500X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine",
"state": "OH",
"license": "35051175",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0607641",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNISON",
"identifier": "000000221255",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4052254",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000525944",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "363514",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCMH",
"identifier": "0607641",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BUCKEYE",
"identifier": "745904",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.