NPIMap

Individual provider Active NPI

Ted Faull, MD

  • Geriatric Medicine (Family Medicine) Physician
  • Boardman, OH
National Provider Identifier
1770560724
Registry record updated Apr 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
35.091967 Issued in OH
Practice address
900 Trailwood Dr
Boardman, OH 44512-5007
Phone
(330) 726-2575
Fax
(330) 921-9319
NPI assigned
Dec 29, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 9, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 36082109 IL
Geriatric Medicine (Family Medicine) Physician 207QG0300X 35.091967 OH Primary

Addresses

Primary practice location

900 Trailwood Dr
Boardman, OH 44512-5007

Mailing address

7341 Eisenhower Dr
Youngstown, OH 44512-5900
Phone (330) 729-8977

Other identifiers 1

IdentifierTypeStateIssuer
2890359MedicaidOH

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
I20090106000001 OH Practitioner - Family Practice 7618881053 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Pennsylvania State University College of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Health Physicians Youngstown, LLCGroup PAC ID 9234318270, 116 clinicians

Practice addresses (Care Compare)

7341 Eisenhower Dr
Boardman, OH 44512-5900
Phone (330) 726-1138

Hospital & facility affiliations

  • Patriot Homecare, Inc Home health agency, Girard, OH, CCN 368406
  • At Home With Shepherd Home health agency, Austintown, OH, CCN 367741
  • MH St Elizabeth Youngstown Hospital Hospital, Youngstown, OH, CCN 360064
  • HMHP St Elizabeth Boardman Health Center Hospital, Boardman, OH, CCN 360276
  • Surgical Hospital at Southwoods Hospital, Youngstown, OH, CCN 360352

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
36082109ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Physicians Youngstown LLC CurrentSince Apr 29, 2019 Accepting new patients
Mercy Health Physicians Youngstown, LLC Family Medicine CurrentSince Apr 29, 2019 Accepting new patients
Youngstown Ohio Outpatient Services Company LLC Past Accepting new patients

Locations

1044 Belmont Ave
Youngstown, OH 44504
Phone (330) 480-2182

900 Trailwood Dr
Youngstown, OH 44512
Phone (330) 726-2575

7341 Eisenhower Dr
Youngstown, OH 44512
Phone (330) 726-1138

Interoperability endpoints

  • Direct secure messaging: tfaull51626@direct.bsmhealth.org

Organizations & group practices 3

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 6

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": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712620800000",
    "number": "1770560724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7341 EISENHOWER DR",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445125900",
            "telephone_number": "330-729-8977",
            "fax_number": "330-729-8959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 TRAILWOOD DR",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445125007",
            "telephone_number": "330-726-2575",
            "fax_number": "330-921-9319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAULL",
        "first_name": "TED",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-29",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "36082109",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "OH",
            "license": "35.091967",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2890359",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boardman, OH

Sources for this page

Verify at the official NPI Registry.