NPIMap

Individual provider Active NPI

Susan Ann Hollobaugh, P.A.

  • Physician Assistant
  • Mentor, OH
National Provider Identifier
1710181532
Registry record updated Mar 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1142 Issued in OH
Practice address
9500 Mentor Ave
Suite 100
Mentor, OH 44060-8713
Phone
(440) 352-4880
Fax
(440) 352-3629
NPI assigned
Jun 14, 2007
Last updated
Mar 3, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 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 1142 OH Primary

Addresses

Primary practice location

9500 Mentor Ave
Suite 100
Mentor, OH 44060-8713

Mailing address

9500 Mentor Avenue
Suite 100
Mentor, OH 44060-8713
Phone (440) 352-4880

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Susan.Hollobaugh@lhpg.cernerdirect.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
I20110725000352 OH Practitioner - Physician Assistant 4183892870 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lake Hospital System, Inc.Group PAC ID 6002713922, 92 clinicians

Practice addresses (Care Compare)

11100 Euclid Ave
Cleveland, OH 44106-1716

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

9500 Mentor Ave
Mentor, OH 44060-8714

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Hospital System, Inc CurrentSince Sep 18, 2000 Accepting new patients
Lake Hospital System, Inc. CurrentSince Sep 18, 2000 Accepting new patients
Lake Hospital System, Inc Past Accepting new patients

Locations

9500 Mentor Ave
Ste 100
Mentor, OH 44060
Phone (440) 352-4880

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

Interoperability endpoints

  • Direct secure messaging: shollobaugh28450@ehrdirect.uhhospitals.org
  • Direct secure messaging: susan.hollobaugh@lhpg.cernerdirect.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1181779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614729600000",
    "number": "1710181532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9500 MENTOR AVENUE",
            "address_2": "SUITE 100",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440608713",
            "telephone_number": "440-352-4880",
            "fax_number": "440-352-3629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 MENTOR AVE",
            "address_2": "SUITE 100",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440608713",
            "telephone_number": "440-352-4880",
            "fax_number": "440-352-3629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLOBAUGH",
        "first_name": "SUSAN",
        "middle_name": "ANN",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-14",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "1142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Susan.Hollobaugh@lhpg.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Baseline West Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "9500 Mentor Ave",
            "address_2": "Suite 100",
            "city": "Mentor",
            "state": "OH",
            "country_code": "US",
            "postal_code": "440608713",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mentor, OH

Sources for this page

Verify at the official NPI Registry.