Michelle K Idada, MPAS, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

50.004077RX Issued in OH

Practice address

9500 Euclid Ave
Mail Code A40
Cleveland, OH 44195-0001

Phone

(216) 692-7239

Fax

(216) 692-7802

NPI assigned

Aug 26, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Michelle K Clough Former name

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• The Cleveland Clinic Foundation

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1679525919
  Medicare reassignment NPD
• Marymount Hospital, Inc.

  • Anatomic Pathology & Clinical Pathology Physician
  • Garfield Heights, OH
  • NPI 1720031131
  Medicare reassignment

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

{
    "created_epoch": "1409011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558483200000",
    "number": "1891195939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9500 EUCLID AVE",
            "address_2": "MAIL CODE A40",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441950001",
            "telephone_number": "216-445-7408",
            "fax_number": "216-445-6255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 EUCLID AVE",
            "address_2": "MAIL CODE A40",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441950001",
            "telephone_number": "216-692-7239",
            "fax_number": "216-692-7802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDADA",
        "first_name": "MICHELLE",
        "middle_name": "K",
        "credential": "MPAS, PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-26",
        "last_updated": "2019-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OH",
            "license": "50.004077RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "CLOUGH",
            "middle_name": "K",
            "credential": "MPAS, PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sidonie Ibrikji, MD
• Deirdre Ice, RN
• Jonah Ice
• Harold Melvin Ickes II
• Daveida Id-Deen
• Ideis Transportaion (On Time Mobility)
• Bette K Idemoto, PHD RN CCRN CS
• Cristian Iditoiu, M.D.
• Maksat Idris, MD
• Carolyn E Ievers-Landis, PHD

• Surgical Physician Assistant in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Surgical Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.