Individual provider Active NPI

Kristi Lyn Mareth, PA

  • Physician Assistant
  • Cleveland, OH
National Provider Identifier
1730360462
Registry record updated Apr 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.002701 Issued in OH
Practice address
9500 Euclid Ave # A40
Cleveland, OH 44195-1932
Phone
(216) 445-7164
NPI assigned
Nov 22, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2020

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 50.002701 OH Primary

Addresses

Primary practice location

9500 Euclid Ave # A40
Cleveland, OH 44195-1932

Mailing address

9500 Euclid Ave # A40
Cleveland, OH 44195-0001
Phone (216) 445-7164

Other practice location 1

316 Clark St
Cambridge, OH 43725-1932
Phone (740) 432-2718

Other names 1

  • Kristi Lyn Jackson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080124000188 OH Practitioner - Physician Assistant 9234211640 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cleveland ClinicGroup PAC ID 1850203555, 6,954 clinicians

Practice addresses (Care Compare)

6770 Mayfield Rd
Cleveland, OH 44124-2299
Phone (440) 461-6430

8950 Euclid Ave
Cleveland, OH 44195-0001
Phone (216) 444-8950

9500 Euclid Ave
Cleveland, OH 44195-0001

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50.002701OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Cleveland Clinic Foundation CurrentSince Jun 28, 2016 Accepting new patients
The Cleveland Clinic Foundation CurrentSince Jun 28, 2016 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

9500 Euclid Ave
#A40
Cleveland, OH 44195
Phone (216) 444-2606

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270

18901 Lake Shore Blvd
Euclid, OH 44119
Phone (216) 531-9000

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 2

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": "1195689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586736000000",
    "number": "1730360462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9500 EUCLID AVE # A40",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441950001",
            "telephone_number": "216-445-7164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 EUCLID AVE # A40",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441951932",
            "telephone_number": "216-445-7164"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "316 Clark St",
            "address_purpose": "LOCATION",
            "city": "Cambridge",
            "state": "OH",
            "postal_code": "437251932",
            "country_code": "US",
            "telephone_number": "740-432-2718",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARETH",
        "first_name": "KRISTI",
        "middle_name": "LYN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-22",
        "last_updated": "2020-04-13",
        "certification_date": "2020-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.002701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTI",
            "last_name": "JACKSON",
            "middle_name": "LYN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.