NPIMap

Individual provider Active NPI

Carissa M Elkins, MD

  • Family Medicine Physician
  • Jackson Center, OH
National Provider Identifier
1881114635
Registry record updated Jul 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35.140064 Issued in OH
Practice address
805 E Pike St
Jackson Center, OH 45334-6001
Phone
(937) 596-0456
Fax
(937) 596-0462
NPI assigned
Jun 22, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2020

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 35.140064 OH Primary

Addresses

Primary practice location

805 E Pike St
Jackson Center, OH 45334-6001

Mailing address

805 E Pike St
Jackson Center, OH 45334-6001
Phone (937) 596-0456

Other practice location 1

502 E Monroe St
Rapid City, SD 57701-1400
Phone (605) 755-4060

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
I20200710002344 OH Practitioner - Family Practice 3779855770 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
JC Edwards School of Medicine, Marshall University, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mary Rutan HospitalGroup PAC ID 9032013792, 90 clinicians

Practice addresses (Care Compare)

805 E Pike St
Jackson Center, OH 45334-6001
Phone (937) 596-0456

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.140064OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mary Rutan Hospital Current Accepting new patients
Mary Rutan Hospital Family Medicine CurrentSince Aug 31, 2020 Accepting new patients
Mary Rutan Hospital CurrentSince Aug 31, 2020 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Mary Rutan Hospital Family Medicine Past Accepting new patients

Locations

1134 N Main St
Ste 1100
Bellefontaine, OH 43311
Phone (937) 651-6820

2231 Timber Trl
Bellefontaine, OH 43311
Phone (937) 599-3115

205 E Palmer Rd
Bellefontaine, OH 43311
Phone (937) 592-4015

120 W Main St
Russells Point, OH 43348
Phone (937) 843-2048

8200 State Route 366
Ste 8
Russells Pt, OH 43348
Phone (937) 292-5063

1880 E US Highway 36
Urbana, OH 43078
Phone (937) 484-3500

209 Lippincott Ln
Urbana, OH 43078
Phone (937) 599-7058

500 N Westminster St
Waynesfield, OH 45896
Phone (419) 568-9100

Organizations & group practices 5

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 6

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": "1498089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593993600000",
    "number": "1881114635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 E PIKE ST",
            "city": "JACKSON CENTER",
            "state": "OH",
            "postal_code": "453346001",
            "telephone_number": "937-596-0456",
            "fax_number": "937-596-0462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 E PIKE ST",
            "city": "JACKSON CENTER",
            "state": "OH",
            "postal_code": "453346001",
            "telephone_number": "937-596-0456",
            "fax_number": "937-596-0462"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "502 E Monroe St",
            "address_purpose": "LOCATION",
            "city": "Rapid City",
            "state": "SD",
            "postal_code": "577011400",
            "country_code": "US",
            "telephone_number": "605-755-4060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELKINS",
        "first_name": "CARISSA",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-22",
        "last_updated": "2020-07-06",
        "certification_date": "2020-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.140064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson Center, OH

Sources for this page

Verify at the official NPI Registry.