Mary Teresa Sivik, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

35069922 Issued in OH

Practice address

6701 Rockside Rd
Suite 330
Independence, OH 44131-2358

Phone

(216) 524-4009

Fax

(216) 524-7933

NPI assigned

Apr 25, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Ohio State University College of Medicine, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northcoast Dermatology Associates, Inc.Group PAC ID 0648212167, 5 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: msivik36036@ehrdirect.uhhospitals.org

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.

• Northcoast Dermatology Associates, Inc.

  • Dermatology Physician
  • Independence, OH
  • NPI 1750347480
  Medicare reassignment Care Compare group NPD
• Northcoast Dermatology Associates, Inc.

  • Dermatology Physician
  • Independence, OH
  • NPI 1780994517
  NPD
• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194566400000",
    "number": "1841256013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6701 ROCKSIDE RD",
            "address_2": "SUITE 330",
            "city": "INDEPENDENCE",
            "state": "OH",
            "postal_code": "441312358",
            "telephone_number": "216-524-4009",
            "fax_number": "216-524-7933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6701 ROCKSIDE RD",
            "address_2": "SUITE 330",
            "city": "INDEPENDENCE",
            "state": "OH",
            "postal_code": "441312358",
            "telephone_number": "216-524-4009",
            "fax_number": "216-524-7933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIVIK",
        "first_name": "MARY",
        "middle_name": "TERESA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-25",
        "last_updated": "2007-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OH",
            "license": "35069922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUMMACARE/APEX",
            "identifier": "T69922",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000139991",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0288031",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennalee Danielle Simon, AGPCNP
• Sincere Hearts Home Care LLC
• Sincere Hearts Home Care LLC
• Victoria Sirna
• Amy Sisley
• Cassandra Skul, PMHNP
• Daniel Skully, APRN
• Michael Joseph Skuza, O.D.
• Ronald Joseph Skuza, OD
• Sydney Smienski

• Dermatology Physician in Independence, OH
• Providers in Independence, OH by specialty
• Dermatology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2007; 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.
• 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.