Individual provider Active NPI

Mark J Tereletsky, DO

  • Internal Medicine Physician
  • Orrville, OH
National Provider Identifier
1881673614
Registry record updated May 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
34-004475 Issued in OH
Practice address
830 S Main St
Orrville, OH 44667-2291
Phone
(330) 684-1300
NPI assigned
Jan 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 34-004475 OH Primary

Addresses

Primary practice location

830 S Main St
Orrville, OH 44667-2291

Mailing address

323 Marion Ave NW
Suite 200
Massillon, OH 44646-3639
Phone (330) 837-1111

Other identifiers 1

IdentifierTypeStateIssuer
0686057MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051213000847 OH Practitioner - Internal Medicine 8426079849 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of North Texas HSC, College of Osteopathic Med, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bloomington Medical Services LLCGroup PAC ID 9032297627, 106 clinicians

Practice addresses (Care Compare)

1761 Beall Ave
Wooster, OH 44691-2342
Phone (330) 263-8326

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.09 of 100Reported as group
Quality
59.24
Promoting interoperability
99
Improvement activities
40
Cost
78.55

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34-004475OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hospitalist Medicine Physicians of Richland County, LTD Internal Medicine CurrentSince Jun 1, 2016 Accepting new patients
Bloomington Medical Services LLC Internal Medicine CurrentSince Oct 31, 2012 Accepting new patients
City of Wooster Past Accepting new patients

Locations

1320 Timken Mercy Dr NW
Canton, OH 44708
Phone (330) 489-1000

830 S Main St
Orrville, OH 44667
Phone (330) 684-2015

1761 Beall Ave
Wooster, OH 44691
Phone (330) 263-8100

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 and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1136937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274918400000",
    "number": "1881673614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "323 MARION AVE NW",
            "address_2": "SUITE 200",
            "city": "MASSILLON",
            "state": "OH",
            "postal_code": "446463639",
            "telephone_number": "330-837-1111",
            "fax_number": "330-837-1769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 S MAIN ST",
            "city": "ORRVILLE",
            "state": "OH",
            "postal_code": "446672291",
            "telephone_number": "330-684-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TERELETSKY",
        "first_name": "MARK",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-11",
        "last_updated": "2010-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "34-004475",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0686057",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orrville, OH

Sources for this page

Verify at the official NPI Registry.