NPIMap

Organization Active NPI

Pomerene Gastroenterology

  • Surgery Physician
  • Millersburg, OH
National Provider Identifier
1649720772
Registry record updated Jun 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 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
Last updated
Jun 8, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
HEALTH PROFESSIONALS OF HOLMES COUNTYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 8, 2018

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

Authorized official

Name
Jason Justus
Title
Cfo
Phone
(330) 674-1584

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208600000X OH Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs on the same Medicare enrollment 15

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 15

National Provider Directory

National Provider Directory
Part of
HPHC Cardiac Rehab

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528416000000",
    "number": "1649720772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "981 WOOSTER RD",
            "address_2": "ATTN: MELISSA FIELITZ",
            "city": "MILLERSBURG",
            "state": "OH",
            "postal_code": "446541536",
            "telephone_number": "330-674-1584",
            "fax_number": "330-674-9314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1261 WOOSTER RD STE 210",
            "city": "MILLERSBURG",
            "state": "OH",
            "postal_code": "44654",
            "telephone_number": "330-763-2018",
            "fax_number": "330-763-2063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POMERENE GASTROENTEROLOGY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HEALTH PROFESSIONALS OF HOLMES COUNTY",
        "enumeration_date": "2016-10-13",
        "last_updated": "2018-06-08",
        "status": "A",
        "authorized_official_last_name": "JUSTUS",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "330-674-1584"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Millersburg, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.