Hartville Internal Medicine PA
Organization Active NPI Internal Medicine Physician · Minerva, OH
NPI 1689665044 · NPPES record last updated May 2, 2012
Key facts
- NPI
- 1689665044
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- HARTVILLE INTERNAL MEDICINE PA
- Practice address
- 200 Carolyn CT
Minerva, OH 44657-8758 - Phone
- (330) 868-4184
- Fax
- (330) 488-2907
- NPI assigned
- Nov 3, 2005
- Organization subpart
- Yes
- Parent organization (as reported)
- HARTVILLE INTERNAL MEDICINE PA
Authorized official
- Name
- Amin Youssef Khalil, M.D.
- Title
- President
- Phone
- (330) 877-9388
Other NPIs on the same Medicare enrollment 2
Corporate family (same tax ID) 2
Practitioners 1
-
Amin Youssef Khalil, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 36D1025184 | Minerva Medical Center | Certificate of waiver | Apr 30, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041207000117 | OH | Part B Supplier - Clinic/Group Practice | 8820054307 |
Receives reassigned benefits from 1 practitioner 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: East Canton, OH; Minerva, OH; Hartville, OH |
National Provider Directory
- Tax ID family
- Hartville Internal Medicine PA
- Part of
- Hartville Internal Medicine PA
Locations
855 W Maple St
#9840
Hartville, OH 44632
200 Carolyn Ct
#9840
Minerva, OH 44657
Phone (330) 868-4184
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
200 Carolyn CT
Minerva, OH 44657-8758
Mailing address
200 Carolyn CT
Minerva, OH 44657-8758
Phone (330) 868-4184
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000342549 | Other | OH | ANTHEM |
| 2535742 | Medicaid | OH |
Other names
- Minerva Medical Center
Other providers in Minerva, OH
- Cheryl A. Gilson
- Great Trail Care Center
- Great Trail Care, LLC
- Linda Sue Green
- Cathleen Ann Harp
- Robin Lynn Higgins
- Karen S Hines
- Brandon Hixenbaugh
- Karleigh Holderbaum
- Kelsi Hulit
All providers in Minerva, OH · Internal Medicine 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 May 2, 2012. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.