NPIMap

Individual provider Active NPI

Fredric Howard Itzkowitz, D.O.

  • Surgery Physician
  • Sandusky, OH
National Provider Identifier
1649266362
Registry record updated Sep 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
34005902 Issued in OH
Practice address
703 Tyler St
Suite 150
Sandusky, OH 44870-3367
Phone
(419) 625-8722
Fax
(419) 625-8436
NPI assigned
Sep 27, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 25, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 34005902 OH Primary

Addresses

Primary practice location

703 Tyler St
Suite 150
Sandusky, OH 44870-3367

Mailing address

PO Box 378
Sandusky, OH 44871-0378
Phone (419) 626-6161

Other identifiers 1

IdentifierTypeStateIssuer
0103042MedicaidOH

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
I20100804000035 OH Practitioner - General SurgeryPractitioner - Colorectal Surgery (Proctology) 2567564156 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General SurgeryAlso: Colorectal Surgery (Proctology)
Education
New York College of Osteo Medicine of New York Institute of Technology, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Coast Professional Company, LLC 105 clinicians

Practice addresses (Care Compare)

1111 Hayes Ave
Sandusky, OH 44870-3323
Phone (419) 557-7400

703 Tyler St
Sandusky, OH 44870-3391

703 Tyler St
Suite 151
Sandusky, OH 44870-3392
Phone (419) 627-0207

Hospital & facility affiliations

  • Firelands Regional Medical Center Hospital, Sandusky, OH, CCN 360025
  • Bellevue Hospital Hospital, Bellevue, OH, CCN 360107

Merit-based Incentive Payment System (MIPS)

Final score
80.23 of 100Reported as group
Quality
59.13
Promoting interoperability
99
Improvement activities
40
Cost
75.81

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy29
Hernia repair - groin (open)1-10
Mastectomy19
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5902OHMDRegistered Dietitian
34005902OHMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Ohio Medical Specialists, LLC CurrentSince Aug 14, 2017 Accepting new patients
North Coast Professional Company, LLC CurrentSince Mar 1, 2026 Accepting new patients
North Coast Professional Company, LLC CurrentSince Mar 1, 2026 Accepting new patients
Northern Ohio Medical Specialists LLC Surgery CurrentSince Aug 14, 2017 Accepting new patients
Northern Ohio Medical Specialists, LLC Past Accepting new patients
Firelands Regional Medical Center Past Accepting new patients

Locations

703 Tyler St
Ste 150
Sandusky, OH 44870
Phone (419) 625-8722

3004 Hayes Ave
Sandusky, OH 44870
Phone (419) 625-2841

Interoperability endpoints

  • Direct secure messaging: fitzkowitz20336@nomshealthcare.direct-ci.com

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Firelands Professional CenterSandusky, OH, CCN 360025 Hospital Corporate Director Apr 25, 2005
Firelands Regional Medical CenterSandusky, OH, CCN 36T025 Hospital Corporate Director Apr 25, 2005
Firelands Regional Medical Center Home Health ServicesSandusky, OH, CCN 367691 Home health agency Corporate Director Apr 25, 2005

Owned or controlled facilities with NPI records 7

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

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 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": "1127779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537833600000",
    "number": "1649266362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 378",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448710378",
            "telephone_number": "419-626-6161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 TYLER ST",
            "address_2": "SUITE 150",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448703367",
            "telephone_number": "419-625-8722",
            "fax_number": "419-625-8436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ITZKOWITZ",
        "first_name": "FREDRIC",
        "middle_name": "HOWARD",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-27",
        "last_updated": "2018-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "34005902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0103042",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandusky, OH

Sources for this page

Verify at the official NPI Registry.