Mercy Professional Care, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

MERCY PROFESSIONAL CARE, LLC

Practice address

1320 Mercy Dr NW
Second Floor Mercy Hall
Canton, OH 44708-2614

Phone

(330) 471-5930

Fax

(330) 471-5938

NPI assigned

Jul 23, 2006

Last updated

Jan 4, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Tim Longville

Title

Chief Accounting Officer and Contro

Phone

(216) 636-7416

Specialties & licenses 11

Addresses

Other identifiers 1

Other names 1

• Mercy Professional Care Corp Former legal business name

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• The Cleveland Clinic Foundation

  dba Cleveland Clinic Orthapedics and Rheumatology at Hillcrest

  • Durable Medical Equipment & Medical Supplies
  • Mayfield HTS, OH
  • NPI 1780991794

  Member Of

  NPD member

Locations

Practitioners 168

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.

• Yara T Abuaita, DO

  • Family Medicine Physician
  • Uniontown, OH
  • NPI 1396367702
  Medicare reassignment Care Compare group NPD
• Alaa Al Saif, M.D.

  • Family Medicine Physician
  • Massillon, OH
  • NPI 1730332909
  Medicare reassignment Care Compare group NPD
• Gregory Boone, MD

  • Surgery Physician
  • Canton, OH
  • NPI 1407854516
  Medicare reassignment Care Compare group NPD
• James Robert Cardella, M.D.

  • Surgery Physician
  • Canton, OH
  • NPI 1619210481
  Medicare reassignment Care Compare group NPD
• Abigail Christiansen

  • Surgery Physician
  • Canton, OH
  • NPI 1295266211
  Medicare reassignment Care Compare group NPD
• Joshua R Dahlheimer

  • Family Nurse Practitioner
  • Akron, OH
  • NPI 1316375629
  Medicare reassignment Care Compare group NPD
• Son N Dang, MD

  • Family Medicine Physician
  • Massillon, OH
  • NPI 1699764944
  Medicare reassignment Care Compare group NPD
• Jaime Demarco, FNP-C

  • Nurse Practitioner
  • Canton, OH
  • NPI 1770854440
  Medicare reassignment Care Compare group NPD
• Jagan Devarajan, M.D

  • Anesthesiology Physician
  • Cleveland, OH
  • NPI 1578730594
  Medicare reassignment Care Compare group NPD
• Gabriel Y El-Hage Boutrous, PHD

  • Psychologist
  • Canton, OH
  • NPI 1285690040
  Medicare reassignment Care Compare group NPD
• Teodora Tzvetanova Fatchikova, M.D.

  • Surgery Physician
  • Canton, OH
  • NPI 1609309228
  Medicare reassignment Care Compare group NPD
• Grace D Goske, CNP

  • Family Nurse Practitioner
  • Akron, OH
  • NPI 1053753517
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672790400000",
    "number": "1902827876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 MERCY DR NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447082614",
            "telephone_number": "330-489-1114",
            "fax_number": "330-489-1281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 MERCY DR NW",
            "address_2": "SECOND FLOOR MERCY HALL",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447082614",
            "telephone_number": "330-471-5930",
            "fax_number": "330-471-5938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY PROFESSIONAL CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-23",
        "last_updated": "2023-01-04",
        "certification_date": "2023-01-03",
        "status": "A",
        "authorized_official_last_name": "LONGVILLE",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER AND CONTRO",
        "authorized_official_telephone_number": "216-636-7416",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OH",
            "license": "35069673",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "OH",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OH",
            "license": "35090597",
            "primary": false
        },
        {
            "code": "207VM0101X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
            "state": "OH",
            "license": null,
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "OH",
            "license": "34009124",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": "OH",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2157366",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Professional Care Corp",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Mercy Professional Care Corp",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Kasey Mercurio, CNP
• Mercy Dental Services
• Mercy Medical Center Home Health & Hospice LLC
• Mercy Medical Center Home Health & Hospice LLC
• Mercy Medical Center, Inc. (Mercy Medical Center Psychiatric Unit)
• Mercy Professional Pharmacy
• Krista Karman Meredith, CNP
• Nicole D Meredith, CDCA
• Stephen Michael Meredith, CNP
• Meridian Pediatrics

• Internal Medicine Physician in Canton, OH
• Providers in Canton, OH by specialty
• Internal Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2023; 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.