Organization Active NPI

Joseph B Masternick DO Inc

  • General Practice Physician
  • Boardman, OH
National Provider Identifier
1710130018
Registry record updated May 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
34-00-2093 Issued in OH
Legal business name
JOSEPH B MASTERNICK DO INC
Practice address
914 Trailwood Dr
Boardman, OH 44512-5007
Phone
(330) 758-4568
Fax
(330) 758-5683
NPI assigned
Oct 30, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 3, 2010

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

Authorized official

Name
Loretta Burnich
Title
Office Manager
Phone
(330) 758-4568

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X 34-00-2093 OH Primary

Addresses

Primary practice location

914 Trailwood Dr
Boardman, OH 44512-5007

Mailing address

PO Box 14290
Poland, OH 44514-7290
Phone (330) 758-4568

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100419000015 OH Part B Supplier - Clinic/Group Practice 4183751464 Receives reassigned benefits from 1 practitioner
Practice locations: New Middletown, OH

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1225324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272844800000",
    "number": "1710130018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14290",
            "city": "POLAND",
            "state": "OH",
            "postal_code": "445147290",
            "telephone_number": "330-758-4568",
            "fax_number": "330-758-5683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 TRAILWOOD DR",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445125007",
            "telephone_number": "330-758-4568",
            "fax_number": "330-758-5683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOSEPH B MASTERNICK DO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-30",
        "last_updated": "2010-05-03",
        "status": "A",
        "authorized_official_last_name": "BURNICH",
        "authorized_official_first_name": "LORETTA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "330-758-4568"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "OH",
            "license": "34-00-2093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boardman, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2010; 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.