Individual provider Active NPI

Christine Miceli, PA-C

  • Physician Assistant
  • Cleveland, OH
National Provider Identifier
1619949534
Registry record updated Aug 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50-001156 Issued in OH
Practice address
18780 Bagley Rd Ste 108
Cleveland, OH 44130-3304
Phone
(440) 816-2330
NPI assigned
Feb 3, 2006
Last updated
Aug 4, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2023

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 50-001156 OH Primary

Addresses

Primary practice location

18780 Bagley Rd Ste 108
Cleveland, OH 44130-3304

Mailing address

PO Box 638269
Cincinnati, OH 45263-8269

Other identifiers 2

IdentifierTypeStateIssuer
000000329801OtherOHANTHEM
000000360051OtherOHANTHEM

Other names 1

  • Christine Miceli-Hahn Professional name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cmiceli@direct.swgeneral.com Southwest General Medical Group, Inc.

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040519000335 OH Practitioner - Physician Assistant 2860483906 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

15345 Bagley Rd
Middleburg Heights, OH 44130-4825
Phone (440) 743-8400

18697 Bagley Rd
Cleveland, OH 44130-3417
Phone (440) 816-6051

7215 Old Oak Blvd
Cleveland, OH 44130-3340

7255 Old Oak Blvd
Cleveland, OH 44130-3300

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.06 of 100Reported as group
Quality
63.56
Promoting interoperability
100
Improvement activities
40
Cost
73.3

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50-001156OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Outreach Professional Services, Inc CurrentSince Jul 1, 2013 Accepting new patients
Southwest General Medical Group, Inc. CurrentSince Nov 16, 2022 Accepting new patients
Outreach Professional Services Inc CurrentSince Jul 1, 2013 Accepting new patients
Southwest General Medical Group Inc CurrentSince Nov 16, 2022 Accepting new patients
Southwest General Medical Group Inc Past Accepting new patients

Locations

2322 E 22nd St
Ste 207
Cleveland, OH 44115
Phone (216) 363-2578

2475 E 22nd St
Ste 120
Cleveland, OH 44115
Phone (216) 367-9444

18780 Bagley Rd
Ste 108
Middleburg Heights, OH 44130
Phone (440) 816-2330

7215 Old Oak Blvd
Ste A310
Middleburg Heights, OH 44130
Phone (440) 816-2820

7255 Old Oak Blvd
Ste C202
Middleburg Heights, OH 44130
Phone (440) 816-5390

7007 Powers Blvd
Parma, OH 44129
Phone (440) 743-4000

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 1

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": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691107200000",
    "number": "1619949534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 638269",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452638269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18780 BAGLEY RD STE 108",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441303304",
            "telephone_number": "440-816-2330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICELI",
        "first_name": "CHRISTINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-03",
        "last_updated": "2023-08-04",
        "certification_date": "2023-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50-001156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000329801",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000360051",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cmiceli@direct.swgeneral.com",
            "affiliation": "Y",
            "affiliationName": "Southwest General Medical Group, Inc.",
            "address_1": "2322 E 22nd St",
            "address_2": "Suite 207",
            "city": "Cleveland",
            "state": "OH",
            "country_code": "US",
            "postal_code": "441153176",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "CHRISTINE",
            "last_name": "MICELI-HAHN",
            "credential": "PA-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.