NPIMap

Individual provider Active NPI

Abigail Elizabeth Cicero, PA-C

  • Physician Assistant
  • Mentor, OH
National Provider Identifier
1649813700
Registry record updated Feb 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.006245RX Issued in OH
Practice address
8655 Market St Ste 200
Mentor, OH 44060-4170
Phone
(440) 255-7938
NPI assigned
Oct 22, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2021

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 50.006245RX OH Primary

Addresses

Primary practice location

8655 Market St Ste 200
Mentor, OH 44060-4170

Mailing address

9432 Whalers CV
Mentor, OH 44060-4576
Phone (440) 364-5710

Other names 1

  • Abigail Elizabeth Skorupski Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address abigail.cicero@lhpg.eclinicaldirectplus.com Direct

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
I20191205000663 OH Practitioner - Physician Assistant 8426481417 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lake Hospital System, Inc.Group PAC ID 6002713922, 92 clinicians

Practice addresses (Care Compare)

36500 Euclid Ave
Willoughby, OH 44094-4455
Phone (440) 516-0530

8655 Market St
Mentor, OH 44060-4112
Phone (440) 255-6400

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50.006245RXOHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Hospital System, Inc CurrentSince Dec 9, 2019 Accepting new patients
Lake Hospital System Inc CurrentSince Dec 9, 2019 Accepting new patients
Lake Hospital System, Inc PastSince Oct 27, 2019 Accepting new patients

Locations

7590 Auburn Rd
Ste 14
Concord Township, OH 44077
Phone (440) 354-1899

8655 Market St
Mentor, OH 44060
Phone (440) 255-6400

8655 Market St
Ste 200
Mentor, OH 44060
Phone (440) 255-7938

10780 Kinsman Rd
Newbury, OH 44065
Phone (440) 564-5656

Interoperability endpoints

  • Direct secure messaging: acicero28424@ehrdirect.uhhospitals.org

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 5

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": "1571702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614211200000",
    "number": "1649813700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9432 WHALERS CV",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440604576",
            "telephone_number": "440-364-5710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8655 MARKET ST STE 200",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440604170",
            "telephone_number": "440-255-7938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CICERO",
        "first_name": "ABIGAIL",
        "middle_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-22",
        "last_updated": "2021-02-25",
        "certification_date": "2021-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.006245RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "abigail.cicero@lhpg.eclinicaldirectplus.com",
            "affiliation": "N",
            "endpointDescription": "Baseline West Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "8655 Market St Ste 200",
            "city": "Mentor",
            "state": "OH",
            "country_code": "US",
            "postal_code": "440604170",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ABIGAIL",
            "last_name": "SKORUPSKI",
            "middle_name": "ELIZABETH",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mentor, OH

Sources for this page

Verify at the official NPI Registry.