Internal Medicine Specialists of Canton Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

35067956 Issued in OH

Legal business name

INTERNAL MEDICINE SPECIALISTS OF CANTON INC

Practice address

1930 Fulton Rd NW Ste 101
Canton, OH 44709-3526

Phone

(330) 454-9766

Fax

(330) 454-3438

NPI assigned

Feb 8, 2007

Organization subpart

No

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

Authorized official

Name

Agatha Chukwumerije, MDNPI 1093820508

Title

President

Phone

(330) 454-9766

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Agatha A Chukwumerije, MD

  • Internal Medicine Physician
  • Canton, OH
  • NPI 1093820508
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193184000000",
    "number": "1801936786",
    "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": "330-454-9766",
            "fax_number": "330-833-6085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 FULTON RD NW STE 101",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447093526",
            "telephone_number": "330-454-9766",
            "fax_number": "330-454-3438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE SPECIALISTS OF CANTON INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2007-10-24",
        "status": "A",
        "authorized_official_last_name": "CHUKWUMERIJE",
        "authorized_official_first_name": "AGATHA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "330-454-9766",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35067956",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Canton, OH
• Providers in Canton, OH by specialty
• Internal Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.