NPIMap

Individual provider Active NPI

Kenneth Roy Mazer

  • Physician Assistant
  • Ravenna, OH
National Provider Identifier
1558565929
Registry record updated Sep 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.003940RX Issued in OH
Practice address
6847 N Chestnut St
Ravenna, OH 44266-3929
Phone
(330) 493-4443
NPI assigned
Jun 12, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Independent Duty Corpsman 1710I1002X
Physician Assistant 363A00000X 50.003940RX OH Primary

Addresses

Primary practice location

6847 N Chestnut St
Ravenna, OH 44266-3929

Mailing address

10930 Clay St
Montville, OH 44064-9702

Other practice location 1

PSC 814 Box 19
Fpo, AE 09865
Phone 011306972079805

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
I20140212000191 OH Practitioner - Physician Assistant 7315176435 Reassigns benefits to 9 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
George Washington University School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Hospitals Urgent Care, LLCGroup PAC ID 3971985607, 109 clinicians

Practice addresses (Care Compare)

3315 N Ridge Rd E
Suite 700a
Ashtabula, OH 44004-4300
Phone (440) 484-2130

3909 Orange PL
Suite 2100
Beachwood, OH 44122-8400
Phone (440) 809-8810

6900 Ctr St
Mentor, OH 44060-4245
Phone (440) 385-0010

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.26 of 100Reported as group
Quality
86.95
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
84.38 of 100Reported as group
Quality
79.57
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50.003940RXOHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Hometown Urgent Care of Michigan, PC CurrentSince May 8, 2023 Accepting new patients
Hometown Urgent Care of Michigan, P.C. CurrentSince May 8, 2023 Accepting new patients

Locations

6210 Brandt Pike
Huber Heights, OH 45424
Phone (937) 236-8630

Interoperability endpoints

  • Direct secure messaging: kmazer39769@ehrdirect.uhhospitals.org

Organizations & group practices 10

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.

Hospital & facility affiliations 2

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": "1181606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726012800000",
    "number": "1558565929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10930 CLAY ST",
            "city": "MONTVILLE",
            "state": "OH",
            "postal_code": "440649702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6847 N CHESTNUT ST",
            "city": "RAVENNA",
            "state": "OH",
            "postal_code": "442663929",
            "telephone_number": "330-493-4443"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "PSC 814 Box 19",
            "address_purpose": "LOCATION",
            "city": "FPO",
            "state": "AE",
            "postal_code": "09865",
            "country_code": "US",
            "telephone_number": "011306972079805",
            "country_name": "United States",
            "address_type": "MIL"
        }
    ],
    "basic": {
        "last_name": "MAZER",
        "first_name": "KENNETH",
        "middle_name": "ROY",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-12",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.003940RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ravenna, OH

Sources for this page

Verify at the official NPI Registry.