Active NPI
Kathleen Ann Meehan-de la Cruz, M.D.
- Family Medicine Physician
- Lorain, OH
National Provider Identifier
1811972979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 35094465
- Practice address
- 3600 Kolbe Rd Ste 120
Lorain, OH 44053-1652 - Phone
- (440) 960-3954
- Fax
- (440) 960-3956
- NPI assigned
- Dec 13, 2005
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 35094465 | OH | Primary |
Addresses
Primary practice location
3600 Kolbe Rd Ste 120
Lorain, OH 44053-1652
Mailing address
3600 Kolbe Rd Ste 120
Lorain, OH 44053-1652
Phone (440) 960-3954
Other practice location 1
136 North Ridge St
Suite B
Monroeville, OH 44847-9469
Phone (419) 465-2700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2998369 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35094465 | OH | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hospital Medicine Associates of Ohio Professional Corporation | Family Medicine | Past | Accepting new patients |
| Blue Ridge Community Health Services Inc | Family Medicine | Past | Accepting new patients |
| Grace Family Medicine | Family Medicine | Past | Accepting new patients |
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.
-
- Hospitalist Physician
- Norwalk, OH
- NPI 1508168253
Family Medicine
-
dba Brevard Health Center
- Federally Qualified Health Center (FQHC)
- Brevard, NC
- NPI 1750144119
Family Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626220800000",
"number": "1811972979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3600 KOLBE RD STE 120",
"city": "LORAIN",
"state": "OH",
"postal_code": "440531652",
"telephone_number": "440-960-3954",
"fax_number": "440-960-3956"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3600 KOLBE RD STE 120",
"city": "LORAIN",
"state": "OH",
"postal_code": "440531652",
"telephone_number": "440-960-3954",
"fax_number": "440-960-3956"
}
],
"practiceLocations": [
{
"address_1": "136 North Ridge St",
"address_2": "Suite B",
"address_purpose": "LOCATION",
"city": "Monroeville",
"state": "OH",
"postal_code": "448479469",
"country_code": "US",
"telephone_number": "419-465-2700",
"fax_number": "419-465-2744",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MEEHAN-DE LA CRUZ",
"first_name": "KATHLEEN",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-13",
"last_updated": "2021-07-14",
"certification_date": "2021-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OH",
"license": "35094465",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2998369",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lorain, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.