NPIMap

Individual provider Active NPI

Eveline Rusdianto Klenotic, DO, FACS

  • Surgery Physician
  • Canton, OH
National Provider Identifier
1801185541
Registry record updated Jul 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
34.011721 Issued in OH
Practice address
2600 Sixth St SW
Canton, OH 44710-1702
Phone
(330) 344-6000
NPI assigned
Apr 4, 2011
Last updated
Jul 19, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X OH
Surgery Physician 208600000X E-15091 AR
Surgery Physician 208600000X 34.011721 OH Primary

Addresses

Primary practice location

2600 Sixth St SW
Canton, OH 44710-1702

Mailing address

PO Box 80690
Canton, OH 44708-0690
Phone (330) 363-7444

Other practice location 1

4301 W Markham St # 725
Little Rock, AR 72205-7101
Phone (501) 296-1200

Other names 1

  • Eveline Rusdianto Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address eveline.klenotic@lhpg.eclinicaldirectplus.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
I20161013001706 OH Practitioner - General Surgery 0446548093 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summa Physicians LLCGroup PAC ID 2961303532, 692 clinicians
Ohio Physician Professional CorporationGroup PAC ID 2668406059, 143 clinicians

Practice addresses (Care Compare)

1790 Graybill Rd
Green, OH 44685-7993

2600 6TH St SW
Canton, OH 44710-1702
Phone (330) 454-8076

2600 6TH SWST
Canton, OH 44710-1702
Phone (330) 363-1342

2600 W 6TH St
Canton, OH 44710-1702

525 E Market St
Akron, OH 44304-1619

95 Arch St
Suite 215
Akron, OH 44304-1467
Phone (330) 434-4145

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.96 of 100Reported as group
Quality
77.5
Promoting interoperability
99
Improvement activities
40
Cost
74.58

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy15
Melanoma (skin cancer) excision11
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-15091ARMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Hospital System, Inc CurrentSince Aug 31, 2016 Accepting new patients
Aultman Hospital Current Accepting new patients
Ohio Physician Professional Corporation Surgery CurrentSince Aug 14, 2023 Accepting new patients
Summa Physicians LLC CurrentSince Nov 18, 2025 Accepting new patients
Lake Hospital System, Inc CurrentSince Aug 31, 2016 Accepting new patients
Lake Hospital System Inc Surgery Current Accepting new patients
Summa Physicians LLC Surgery CurrentSince Nov 18, 2025 Accepting new patients
Summa Physicians LLC Past Accepting new patients

Locations

525 E Market St
Akron, OH 44304
Phone (330) 375-6350

2600 6th St SW
Canton, OH 44710
Phone (330) 363-2180

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

5105 Som Center Rd
Ste 107
Willoughby, OH 44094
Phone (440) 655-8389

Interoperability endpoints

  • Direct secure messaging: eveline.klenotic@direct.aultman.org

Organizations & group practices 9

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 4

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": "1301875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689724800000",
    "number": "1801185541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80690",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447080690",
            "telephone_number": "330-363-7444",
            "fax_number": "330-363-7770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 SIXTH ST SW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447101702",
            "telephone_number": "330-344-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4301 W Markham St # 725",
            "address_purpose": "LOCATION",
            "city": "Little Rock",
            "state": "AR",
            "postal_code": "722057101",
            "country_code": "US",
            "telephone_number": "501-296-1200",
            "fax_number": "501-686-8551",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KLENOTIC",
        "first_name": "EVELINE",
        "middle_name": "RUSDIANTO",
        "credential": "DO, FACS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-04",
        "last_updated": "2023-07-19",
        "certification_date": "2023-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AR",
            "license": "E-15091",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "34.011721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "eveline.klenotic@lhpg.eclinicaldirectplus.com",
            "affiliation": "N",
            "endpointDescription": "Baseline West Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "5105 SOM Center Road",
            "address_2": "Suite 107",
            "city": "Willoughby",
            "state": "OH",
            "country_code": "US",
            "postal_code": "44094",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "EVELINE",
            "last_name": "RUSDIANTO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Canton, OH

Sources for this page

Verify at the official NPI Registry.