Individual provider Active NPI

Kelli M. Pittak, CNP

  • Family Nurse Practitioner
  • Lorain, OH
National Provider Identifier
1831568658
Registry record updated Jul 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN.CNP.18146 Issued in OH
Practice address
3600 Kolbe Rd Ste 106
Lorain, OH 44053-1652
Phone
(440) 960-3954
Fax
(440) 960-3956
NPI assigned
Sep 22, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN.CNP.18146 OH Primary

Addresses

Primary practice location

3600 Kolbe Rd Ste 106
Lorain, OH 44053-1652

Mailing address

3600 Kolbe Rd Ste 106
Lorain, OH 44053-1652
Phone (440) 960-3954

Other names 1

  • Kelli M. Spontik Former name

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151023001476 OH Practitioner - Nurse Practitioner 4385953884 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Health Physicians Lorain Specialty Care LLCGroup PAC ID 4688070055, 134 clinicians
Mercy Health Physicians Lorain LLCGroup PAC ID 1355474172, 41 clinicians
Mercy Health-Allen Hospital LLCGroup PAC ID 5092802389, 14 clinicians

Practice addresses (Care Compare)

1813 Nagel Rd
Suite 500
Avon, OH 44011-6401
Phone (440) 324-0400

3600 Kolbe Rd
Suite 106
Lorain, OH 44053-1652
Phone (440) 960-3954

840 Patriot Dr
Wellington, OH 44090-8948
Phone (440) 647-2225

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN.CNP.18146OHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health-Allen Hospital LLC CurrentSince Jul 22, 2019 Accepting new patients
Mercy Health Physicians Lorain Specialty Care LLC CurrentSince Sep 1, 2021 Accepting new patients
Mercy Health-Allen Hospital LLC CurrentSince Jul 22, 2019 Accepting new patients
Mercy Health-Allen Hospital LLC Current Accepting new patients
Mercy Health Physicians Lorain, LLC CurrentSince Jul 22, 2019 Accepting new patients
Mercy Health Physicians, Lorain, LLC CurrentSince Jul 22, 2019 Accepting new patients
Mercy Health Physicians Lorain Specialty Care LLC CurrentSince Sep 1, 2021 Accepting new patients

Locations

578 N Leavitt Rd
Amherst, OH 44001
Phone (440) 960-3912

1813 Nagel Rd
Ste 500
Avon, OH 44011
Phone (440) 324-0400

3600 Kolbe Rd
Ste 106
Lorain, OH 44053
Phone (440) 222-4970

840 Patriot Dr
Wellington, OH 44090
Phone (440) 647-2225

Interoperability endpoints

  • Direct secure messaging: kpittak263122@direct.bsmhealth.org

Organizations & group practices 7

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.

Hospital & facility affiliations 3

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": "1442880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562630400000",
    "number": "1831568658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 KOLBE RD STE 106",
            "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 106",
            "city": "LORAIN",
            "state": "OH",
            "postal_code": "440531652",
            "telephone_number": "440-960-3954",
            "fax_number": "440-960-3956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PITTAK",
        "first_name": "KELLI",
        "middle_name": "M.",
        "name_prefix": "Mrs.",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-22",
        "last_updated": "2019-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.18146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLI",
            "last_name": "SPONTIK",
            "middle_name": "M.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lorain, OH

Sources for this page

Verify at the official NPI Registry.