NPIMap

Individual provider Active NPI

Maryann Chinyelu Fisher, M.D.

  • Family Medicine Physician
  • Westerville, OH
National Provider Identifier
1578094090
Registry record updated Sep 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35.140300 Issued in OH
Practice address
477 Cooper Rd Ste 300
Westerville, OH 43081-8057
Phone
(614) 898-8808
Fax
(614) 898-8842
NPI assigned
Mar 26, 2017
Last updated
Sep 19, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 35.140300 OH Primary

Addresses

Primary practice location

477 Cooper Rd Ste 300
Westerville, OH 43081-8057

Mailing address

477 Cooper Rd Ste 300
Westerville, OH 43081-8057
Phone (614) 898-8808

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20201210002462 IL Practitioner - Family Practice 4486926748 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

124 SW Adams St
Peoria, IL 61602-1308

2200 Fort Jesse Rd
Normal, IL 61761-6286

8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Dec 1, 2020 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Cardinal Medical Group, LTD. Family Medicine Past Accepting new patients

Locations

2200 Fort Jesse Rd
Ste 110
Normal, IL 61761
Phone (309) 661-6250

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

1405 W Park St
Urbana, IL 61801
Phone (217) 337-2430

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 5

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": "1490486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600473600000",
    "number": "1578094090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "477 COOPER RD STE 300",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430818057",
            "telephone_number": "614-898-8808",
            "fax_number": "614-898-8842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "477 COOPER RD STE 300",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430818057",
            "telephone_number": "614-898-8808",
            "fax_number": "614-898-8842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISHER",
        "first_name": "MARYANN",
        "middle_name": "CHINYELU",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-26",
        "last_updated": "2020-09-19",
        "certification_date": "2020-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.140300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westerville, OH

Sources for this page

Verify at the official NPI Registry.