NPIMap

Organization Active NPI

Mid-Ohio Emergency Group, LLC

  • Emergency Medicine Physician
  • Mansfield, OH
National Provider Identifier
1881164010
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
MID-OHIO EMERGENCY GROUP, LLC
Practice address
335 Glessner Ave
Mansfield, OH 44903-2269
Phone
(419) 526-8000
NPI assigned
Nov 30, 2018
Last updated
Mar 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

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

Authorized official

Name
Lisha C Falk
Title
VP of Contracting
Phone
(337) 609-1221

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Nurse Practitioner 363L00000X
Emergency Medicine Physician 207P00000X Primary

Addresses

Primary practice location

335 Glessner Ave
Mansfield, OH 44903-2269

Mailing address

200 Corporate Blvd
Lafayette, LA 70508-3870
Phone (800) 893-9698

Other practice location 1

1365 N Lexington Springmill Rd
Ontario, OH 44906-1126
Phone (419) 520-3000

Other practice location 2

199 W Main St
Shelby, OH 44875-1490
Phone (419) 342-5015

Other identifiers 2

IdentifierTypeStateIssuer
H673150OtherOHMEDICARE OF OHIO
0327030MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190117001823 OH Part B Supplier - Clinic/Group Practice 7810233517 Receives reassigned benefits from 133 practitioners
Practice locations: Ashland, OH; Mansfield, OH; Ontario, OH; Shelby, OH

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 136

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 136

NPI Registry JSON

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

{
    "created_epoch": "1543536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647993600000",
    "number": "1881164010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CORPORATE BLVD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083870",
            "telephone_number": "800-893-9698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 GLESSNER AVE",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449032269",
            "telephone_number": "419-526-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1365 N Lexington Springmill Rd",
            "address_purpose": "LOCATION",
            "city": "Ontario",
            "state": "OH",
            "postal_code": "449061126",
            "country_code": "US",
            "telephone_number": "419-520-3000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "199 W Main St",
            "address_purpose": "LOCATION",
            "city": "Shelby",
            "state": "OH",
            "postal_code": "448751490",
            "country_code": "US",
            "telephone_number": "419-342-5015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MID-OHIO EMERGENCY GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-30",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A",
        "authorized_official_last_name": "FALK",
        "authorized_official_first_name": "LISHA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "VP OF CONTRACTING",
        "authorized_official_telephone_number": "337-609-1221"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE OF OHIO",
            "identifier": "H673150",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0327030",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mansfield, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.