NPIMap

Individual provider Active NPI

Devon T Ksiazk, PA

  • Physician Assistant
  • Westerville, OH
National Provider Identifier
1619244696
Registry record updated Jan 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.003412 Issued in OH
Practice address
400 Altair Pkwy Ste 3200
Westerville, OH 43082-7653
Phone
(614) 392-5160
Fax
(614) 764-1707
NPI assigned
Nov 19, 2011
Last updated
Jan 5, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50.003412 OH Primary

Addresses

Primary practice location

400 Altair Pkwy Ste 3200
Westerville, OH 43082-7653

Mailing address

7281 Sawmill Road
Suite 100
Dublin, OH 43016
Phone (614) 764-0707

Other names 1

  • Devon T Ruen Former name

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
I20140417001157 OH Practitioner - Physician Assistant 6406088871 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Iowa, RJ & L Carver College of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

2600 Airport Dr
Columbus, OH 43219-2242
Phone (614) 447-9495

4895 Olentangy River Rd
Columbus, OH 43214-1185

6201 Gender Rd
Canal Winchester, OH 43110-2007
Phone (614) 834-8042

625 Africa Rd
Westerville, OH 43082-0002

655 Africa Rd
Westerville, OH 43082-9808
Phone (614) 447-9495

725 Buckles CT N
Suite 100
Gahanna, OH 43230-6884
Phone (614) 471-9654

770 Jasonway Ave
Suite G2
Columbus, OH 43214-4333
Phone (614) 459-3687

8050 E Main St
Renoldsburg, OH 43068-2652

8050 E Main St
Suite 1200
Reynoldsburg, OH 43068-2575
Phone (614) 259-0923

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50.003412OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Oh Independent Medical Group LLC CurrentSince Nov 15, 2023 Accepting new patients
Central Ohio Primary Care Physicians, Inc. Physician Assistant CurrentSince Feb 6, 2024 Accepting new patients
Central Ohio Primary Care Physicians Inc Current Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

4885 Olentangy River Rd
Columbus, OH 43214
Phone (614) 326-5665

7281 Sawmill Rd
Ste 100
Dublin, OH 43016
Phone (614) 764-0707

444 N Cleveland Ave
Ste 120
Westerville, OH 43082
Phone (614) 818-0300

655 Africa Rd
Westerville, OH 43082

Interoperability endpoints

  • Direct secure messaging: dksiazk72733@copcp.medicity.net

Organizations & group practices 5

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 6

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": "1321660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704412800000",
    "number": "1619244696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7281 SAWMILL ROAD",
            "address_2": "SUITE 100",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "43016",
            "telephone_number": "614-764-0707",
            "fax_number": "614-764-1707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 ALTAIR PKWY STE 3200",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430827653",
            "telephone_number": "614-392-5160",
            "fax_number": "614-764-1707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KSIAZK",
        "first_name": "DEVON",
        "middle_name": "T",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-19",
        "last_updated": "2024-01-05",
        "certification_date": "2024-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.003412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEVON",
            "last_name": "RUEN",
            "middle_name": "T",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Westerville, OH

Sources for this page

Verify at the official NPI Registry.