NPIMap

Organization Active NPI

Vitreo-Retinal Consultants, Inc.

  • Ophthalmology Physician
  • Canton, OH
National Provider Identifier
1750347662
Registry record updated Oct 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
VITREO-RETINAL CONSULTANTS, INC.
Practice address
4676 Douglas Cir NW
Canton, OH 44718-3619
Phone
(330) 494-1116
Fax
(330) 494-0276
NPI assigned
Apr 21, 2006
Last updated
Oct 6, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2021

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

Authorized official

Name
Mark A. Gersman, M.D.NPI 1205839552
Title
Vice President
Phone
(330) 494-1116

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X NU Primary

Addresses

Primary practice location

4676 Douglas Cir NW
Canton, OH 44718-3619

Mailing address

4676 Douglas Cir NW
Canton, OH 44718-3619
Phone (330) 494-1116

Other identifiers 3

IdentifierTypeStateIssuer
0693576MedicaidOH
6300115000MedicaidWV
0015118480004MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040303000628 OH Part B Supplier - Clinic/Group Practice 5890682835 Receives reassigned benefits from 8 practitioners
Practice locations: Youngstown, OH; Warren, OH; Mentor, OH; Marietta, OH; Dover, OH; Canton, OH; Canfield, OH
O20050425000516 PA Part B Supplier - Clinic/Group Practice 5890682835 Receives reassigned benefits from 8 practitioners
Practice locations: Hermitage, PA; Monaca, PA

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

3695 Boardman Canfield Rd
#B200
Canfield, OH 44406
Phone (330) 533-8851

45 Manor Hill Dr
Ste 200
Canfield, OH 44406
Phone (330) 533-8851

4676 Douglas Cir NW
Canton, OH 44718
Phone (330) 494-1116

7766 Reynolds Rd
Mentor, OH 44060
Phone (440) 918-7417

8140 Norton Pkwy
Mentor, OH 44060
Phone (440) 255-1115

8140 Norton Pkwy
Ste 230
Mentor, OH 44060
Phone (440) 918-7417

2163 Mentor Ave
Painesville, OH 44077
Phone (440) 520-5321

2932 Youngstown Rd SE
Warren, OH 44484
Phone (330) 369-1881

36100 Euclid Ave
Ste 450
Willoughby, OH 44094
Phone (216) 297-3230

3135 Highland Rd
Hermitage, PA 16148
Phone (724) 346-4180

3135 Highland Rd
Ste A
Hermitage, PA 16148
Phone (724) 342-6606

102 Wagner Rd
Monaca, PA 15061
Phone (724) 774-7232

418 Grand Park Dr
Parkersburg, WV 26105
Phone (304) 865-5185

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633478400000",
    "number": "1750347662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4676 DOUGLAS CIR NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447183619",
            "telephone_number": "330-494-1116",
            "fax_number": "330-494-0276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4676 DOUGLAS CIR NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447183619",
            "telephone_number": "330-494-1116",
            "fax_number": "330-494-0276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITREO-RETINAL CONSULTANTS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-21",
        "last_updated": "2021-10-06",
        "certification_date": "2021-10-06",
        "status": "A",
        "authorized_official_last_name": "GERSMAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "330-494-1116",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0693576",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6300115000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0015118480004",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2021; 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.