Active NPI
Demetrius Clark
- Home Health Agency
- Obetz, OH
National Provider Identifier
1851099683
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- Practice address
- 4462 Charlotte Rd
Obetz, OH 43207-5232 - Phone
- (614) 620-2758
- NPI assigned
- Feb 21, 2023
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Primary |
Addresses
Primary practice location
4462 Charlotte Rd
Obetz, OH 43207-5232
Mailing address
4462 Charlotte Rd
Obetz, OH 43207-5232
Phone (614) 620-2758
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1676937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676937600000",
"number": "1851099683",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4462 CHARLOTTE RD",
"city": "OBETZ",
"state": "OH",
"postal_code": "432075232",
"telephone_number": "614-620-2758"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4462 CHARLOTTE RD",
"city": "OBETZ",
"state": "OH",
"postal_code": "432075232",
"telephone_number": "614-620-2758"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "DEMETRIUS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-02-21",
"last_updated": "2023-02-21",
"certification_date": "2023-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Obetz, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.