Active NPI
Amy C Lakritz, M.D.
- Pediatrics Physician
- Canton, OH
National Provider Identifier
1811964380
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 35069524
- Practice address
- 4575 Stephens Cir NW
Canton, OH 44718-3629 - Phone
- (330) 499-9944
- Fax
- (330) 499-3056
- NPI assigned
- Mar 3, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 35069524 | OH | Primary |
Addresses
Primary practice location
4575 Stephens Cir NW
Canton, OH 44718-3629
Mailing address
4575 Stephens Cir NW
Canton, OH 44718-3629
Phone (330) 499-9944
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 341834815 | Other | EMP. TAX I.D. | |
| 0359759 | Medicaid | OH | |
| 0277150 | Medicaid | OH |
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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160920002139 | OH | Order and Referring Only - Pediatric Medicine | 6709173685 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Margaret B Shaley Child Health Clinic Inc | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pediatrics Physician
- Canton, OH
- NPI 1215021126
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141344000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471478400000",
"number": "1811964380",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4575 STEPHENS CIR NW",
"city": "CANTON",
"state": "OH",
"postal_code": "447183629",
"telephone_number": "330-499-9944",
"fax_number": "330-499-3056"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4575 STEPHENS CIR NW",
"city": "CANTON",
"state": "OH",
"postal_code": "447183629",
"telephone_number": "330-499-9944",
"fax_number": "330-499-3056"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAKRITZ",
"first_name": "AMY",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-03",
"last_updated": "2016-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OH",
"license": "35069524",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMP. TAX I.D.",
"identifier": "341834815",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0359759",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0277150",
"state": "OH"
}
],
"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 Aug 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.