Active NPI
Michael Dean Conrad, PC/CR
- Professional Counselor
- Canton, OH
National Provider Identifier
1821221490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 0500075
- Practice address
- 6370 Wise Ave NW
Canton, OH 44720-7350 - Phone
- (330) 493-0083
- Fax
- (330) 493-3689
- NPI assigned
- Aug 31, 2009
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 0500075 | OH | Primary |
Addresses
Primary practice location
6370 Wise Ave NW
Canton, OH 44720-7350
Mailing address
6370 Wise Ave NW
Canton, OH 44720-7350
Phone (330) 493-0083
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 547 | Medicaid | OH | |
| 215-01 | Other | OH | JOB AND FAMILY SERVICES |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0500075 | OH | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pathway Caring for Children | Past | Accepting new patients | |
| Pathway Caring for Childen | Past | Accepting new patients | |
| Pathway Caring for Children | 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.
-
- Case Management Agency
- North Canton, OH
- NPI 1285734277
-
- Community/Behavioral Health Agency
- Canton, OH
- NPI 1720345556
-
- Community/Behavioral Health Agency
- North Canton, OH
- NPI 1912161720
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251676800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251676800000",
"number": "1821221490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6370 WISE AVE NW",
"city": "CANTON",
"state": "OH",
"postal_code": "447207350",
"telephone_number": "330-493-0083",
"fax_number": "330-493-3689"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6370 WISE AVE NW",
"city": "CANTON",
"state": "OH",
"postal_code": "447207350",
"telephone_number": "330-493-0083",
"fax_number": "330-493-3689"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONRAD",
"first_name": "MICHAEL",
"middle_name": "DEAN",
"name_prefix": "Mr.",
"credential": "PC/CR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-08-31",
"last_updated": "2009-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OH",
"license": "0500075",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "547",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "JOB AND FAMILY SERVICES",
"identifier": "215-01",
"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 31, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.