NPIMap

Individual provider Active NPI

Timothy Richard Neely, DO

  • Family Medicine Physician
  • Chardon, OH
National Provider Identifier
1861704140
Registry record updated Mar 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35-010467 Issued in OH
Practice address
510 5TH Ave
Chardon, OH 44024-1076
Phone
(440) 279-1500
Fax
(440) 279-1501
NPI assigned
Jul 2, 2010
Last updated
Mar 3, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35-010467 OH Primary

Addresses

Primary practice location

510 5TH Ave
Chardon, OH 44024-1076

Mailing address

7590 Auburn Road, Suite 014
Attn: Med Staff
Concord TWP., OH 44077-9176
Phone (440) 354-1899

Other identifiers 1

IdentifierTypeStateIssuer
0085189MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address timothy.neely@lhpg.eclinicaldirectplus.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131007001134 OH Practitioner - Family Practice 5597999524 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Ohio University, College of Osteopathic Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lake Hospital System, Inc.Group PAC ID 6002713922, 92 clinicians

Practice addresses (Care Compare)

510 5TH Ave
Chardon, OH 44024-1076
Phone (440) 286-8908

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
35-010467OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Hospital System, Inc Family Medicine CurrentSince Jul 31, 2017 Accepting new patients
Lake Hospital System Inc Family Medicine CurrentSince Jul 31, 2017 Accepting new patients
Lake Hospital System, Inc Family Medicine Past Accepting new patients

Locations

510 5th Ave
Chardon, OH 44024
Phone (440) 285-9494

7590 Auburn Rd
Ste 14
Concord Township, OH 44077
Phone (440) 354-1899

10780 Kinsman Rd
Newbury, OH 44065
Phone (440) 564-5656

36000 Euclid Ave
Willoughby Hills, OH 44094
Phone (440) 375-8166

Interoperability endpoints

  • Direct secure messaging: tneely37122@ehrdirect.uhhospitals.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1278028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614729600000",
    "number": "1861704140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7590 AUBURN ROAD, SUITE 014",
            "address_2": "ATTN: MED STAFF",
            "city": "CONCORD TWP.",
            "state": "OH",
            "postal_code": "440779176",
            "telephone_number": "440-354-1899",
            "fax_number": "440-354-1845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 5TH AVE",
            "city": "CHARDON",
            "state": "OH",
            "postal_code": "440241076",
            "telephone_number": "440-279-1500",
            "fax_number": "440-279-1501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEELY",
        "first_name": "TIMOTHY",
        "middle_name": "RICHARD",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-02",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35-010467",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0085189",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "timothy.neely@lhpg.eclinicaldirectplus.com",
            "affiliation": "N",
            "endpointDescription": "Baseline West Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "510 5th Ave",
            "city": "Chardon",
            "state": "OH",
            "country_code": "US",
            "postal_code": "440241076",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chardon, OH

Sources for this page

Verify at the official NPI Registry.