Active NPI
Mark J. Pellegrino, MD
- Physical Medicine & Rehabilitation Physician
- North Canton, OH
National Provider Identifier
1538170691
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- 35050212
- Practice address
- 6651 Frank Ave NW
North Canton, OH 44720 - Phone
- (330) 498-9865
- Fax
- (330) 498-9869
- NPI assigned
- Aug 11, 2006
- Last updated
- Nov 2, 2016
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 35050212 | OH | Primary |
Addresses
Primary practice location
6651 Frank Ave NW
North Canton, OH 44720
Mailing address
PO Box 26125
Akron, OH 44319-6125
Phone (330) 493-0840
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000141768 | Other | OH | ANTHEM |
| 341750133 | Other | OH | SUMMACARE |
| 0715739 | Medicaid | OH | |
| 341898905030 | Other | OH | CARESOURCE |
| 341898905B | Other | OH | AULTCARE |
| 250011247 | Other | OH | RAILROAD MEDICARE |
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: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Medicine and Rehabilitation
- Education
- Ohio State University College of Medicine, 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
6651 Frank Ave NW
North Canton, OH 44720-8442
Phone (330) 498-9865
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35050212 | OH | MD | Physical Medicine & Rehabilitation Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifecare Family Health and Dental Center, Inc | Past | Accepting new patients |
Interoperability endpoints
- mark.pellegrino@10522.chartlogic.direct-ci.com
Organizations & group practices 2
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.
-
- Interventional Pain Medicine Physician
- North Canton, OH
- NPI 1740234806
-
- Federally Qualified Health Center (FQHC)
- Massillon, OH
- NPI 1134959000
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Genesis Outpatient Pharmacy
- Community/Retail Pharmacy
- Zanesville, OH
- NPI 1477150951
Hospital
-
- General Acute Care Hospital
- Zanesville, OH
- NPI 1598868655
-
dba Genesis Outpatient Pharmacy 1C
- Community/Retail Pharmacy
- Coshocton, OH
- NPI 1710839436
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478044800000",
"number": "1538170691",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 26125",
"city": "AKRON",
"state": "OH",
"postal_code": "443196125",
"telephone_number": "330-493-0840"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6651 FRANK AVE NW",
"city": "NORTH CANTON",
"state": "OH",
"postal_code": "44720",
"telephone_number": "330-498-9865",
"fax_number": "330-498-9869"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PELLEGRINO",
"first_name": "MARK",
"middle_name": "J.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-11",
"last_updated": "2016-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "OH",
"license": "35050212",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000141768",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SUMMACARE",
"identifier": "341750133",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0715739",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARESOURCE",
"identifier": "341898905030",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AULTCARE",
"identifier": "341898905B",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "250011247",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in North Canton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.