Pomerene Gastroenterology
Organization Active NPI Surgery Physician · Millersburg, OH
NPI 1649720772 · NPPES record last updated Jun 8, 2018
Key facts
- NPI
- 1649720772
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Surgery Physician 208600000X
- Legal business name
- POMERENE GASTROENTEROLOGY
- Practice address
- 1261 Wooster Rd Ste 210
Millersburg, OH 44654 - Phone
- (330) 763-2018
- Fax
- (330) 763-2063
- NPI assigned
- Oct 13, 2016
- Organization subpart
- Yes
- Parent organization (as reported)
- HEALTH PROFESSIONALS OF HOLMES COUNTY
Authorized official
- Name
- Jason Justus
- Title
- Cfo
- Phone
- (330) 674-1584
Other NPIs on the same Medicare enrollment 15
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070702000432 | OH | Part B Supplier - Clinic/Group Practice | 6002916194 |
Receives reassigned benefits from 94 practitioners 15 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Berlin, OH; Sugarcreek, OH; Millersburg, OH; Loudonville, OH; Dover, OH |
National Provider Directory
- Part of
- Health Professionals of Holmes County Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician |
208600000X | OH | Yes |
Addresses
Primary practice location
1261 Wooster Rd Ste 210
Millersburg, OH 44654
Mailing address
981 Wooster Rd
Attn: Melissa Fielitz
Millersburg, OH 44654-1536
Phone (330) 674-1584
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2801418 | Medicaid | OH |
Other providers in Millersburg, OH
- Amy Marie Pangalangan Moler
- Lynda Park
- Amanda Rochelle Patterson
- Performance Foot & Ankle, LLC
- Personal Touch Up
- Pomerene Hospital
- Hannah Olivia Pratt
- Precious Angel Transportation
- Premier Hearing Center
- Premier Pharmacy Services Inc
All providers in Millersburg, OH · Surgery Physician in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.