Individual provider Active NPI

Tina Sample, AUD

  • Audiologist
  • Fairlawn, OH
National Provider Identifier
1871879890
Registry record updated Jan 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
A. 01352 Issued in OH
Practice address
3085 W Market St Ste 102
Fairlawn, OH 44333-3620
Phone
(330) 379-9070
Fax
(330) 379-2358
NPI assigned
Oct 24, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X A. 01352 OH Primary

Addresses

Primary practice location

3085 W Market St Ste 102
Fairlawn, OH 44333-3620

Mailing address

3085 W Market St Ste 102
Fairlawn, OH 44333-3620
Phone (330) 379-9070

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260209000269 OH Practitioner - Qualified Audiologist 8729567979 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2003
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

3085 W Market St
Suite 102
Fairlawn, OH 44333-3619

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
A. 01352OHMDAudiologist

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1319414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769817600000",
    "number": "1871879890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3085 W MARKET ST STE 102",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "443333620",
            "telephone_number": "330-379-9070",
            "fax_number": "330-379-2358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3085 W MARKET ST STE 102",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "443333620",
            "telephone_number": "330-379-9070",
            "fax_number": "330-379-2358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMPLE",
        "first_name": "TINA",
        "name_prefix": "Dr.",
        "credential": "AUD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-24",
        "last_updated": "2026-01-31",
        "certification_date": "2026-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "OH",
            "license": "A. 01352",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairlawn, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.