NPIMap

Individual provider Active NPI

Jeffery Reynold Kontak, MD

  • Family Medicine Physician
  • Wooster, OH
National Provider Identifier
1629069133
Registry record updated Aug 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35055953K Issued in OH
Practice address
1740 Cleveland Rd
Wooster, OH 44691-2204
Phone
(330) 287-4918
Fax
(330) 287-4802
NPI assigned
Nov 3, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35055953K OH Primary

Addresses

Primary practice location

1740 Cleveland Rd
Wooster, OH 44691-2204

Mailing address

1740 Cleveland Rd
Cleveland Clinic FHC Wooster
Wooster, OH 44691-2204
Phone (330) 287-4918

Other identifiers 2

IdentifierTypeStateIssuer
000000193119OtherOHANTHEM
0713786MedicaidOH

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
I20071108000380 OH Practitioner - Family Practice 6709876105 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Cincinnati College of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Partners Physician GroupGroup PAC ID 4183529340, 409 clinicians
Cleveland ClinicGroup PAC ID 1850203555, 6,954 clinicians

Practice addresses (Care Compare)

1 Akron General Ave
Akron, OH 44307-2432
Phone (330) 344-1967

8950 Euclid Ave
Cleveland, OH 44195-0001
Phone (216) 444-8950

9500 Euclid Ave
Cleveland, OH 44195-0001

970 E Washington St
Medina, OH 44256-3332
Phone (330) 721-5700

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35055953KOHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Cleveland Clinic Foundation CurrentSince Sep 8, 2015 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

224 W Exchange St
Ste 225
Akron, OH 44302
Phone (330) 344-7400

224 W Exchange St
Ste 160
Akron, OH 44302
Phone (330) 344-6505

1 Akron General Ave
Akron, OH 44307
Phone (330) 344-5760

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270

850 Columbia Rd
Ste 105
Westlake, OH 44145
Phone (440) 250-5737

1740 Cleveland Rd
Wooster, OH 44691
Phone (330) 287-4500

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 and National Provider Directory roles.

Hospital & facility affiliations 7

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": "1130976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313625600000",
    "number": "1629069133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1740 CLEVELAND RD",
            "address_2": "CLEVELAND CLINIC FHC WOOSTER",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446912204",
            "telephone_number": "330-287-4918",
            "fax_number": "330-287-4802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 CLEVELAND RD",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446912204",
            "telephone_number": "330-287-4918",
            "fax_number": "330-287-4802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONTAK",
        "first_name": "JEFFERY",
        "middle_name": "REYNOLD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-03",
        "last_updated": "2011-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35055953K",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000193119",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0713786",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wooster, OH

Sources for this page

Verify at the official NPI Registry.