NPIMap

Individual provider Active NPI

Denise Louise Bobovnyik, MD

  • Family Medicine Physician
  • Canfield, OH
National Provider Identifier
1902876964
Registry record updated Oct 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35054533 Issued in OH
Practice address
3660 Stutz Dr
Ste 102
Canfield, OH 44406-8149
Phone
(330) 702-1585
Fax
(330) 702-1383
NPI assigned
Jan 24, 2006
Last updated
Oct 19, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2016

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 35054533 OH Primary

Addresses

Primary practice location

3660 Stutz Dr
Ste 102
Canfield, OH 44406-8149

Mailing address

3660 Stutz Dr
Ste 102
Canfield, OH 44406-8149
Phone (330) 702-1585

Other identifiers 2

IdentifierTypeStateIssuer
H153520OtherOHMEDICARE PTAN
0703368MedicaidOH

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
I20090303000468 OH Practitioner - Family Practice 1456370915 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Northeastern Ohio University College of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Health Physicians Youngstown, LLCGroup PAC ID 9234318270, 116 clinicians

Practice addresses (Care Compare)

1044 Belmont Ave
Youngstown, OH 44504-1006

3660 Stutz Dr
Suite 102
Canfield, OH 44406-8149
Phone (330) 702-1585

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35054533OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Physicians Youngstown, LLC Family Medicine Current Accepting new patients
Mercy Health Physicians Youngstown LLC CurrentSince Dec 16, 2012 Accepting new patients
Mercy Health Youngstown LLC Past Accepting new patients

Locations

3660 Stutz Dr
Ste 102
Canfield, OH 44406
Phone (330) 702-1585

1044 Belmont Ave
Youngstown, OH 44504
Phone (330) 480-2182

Interoperability endpoints

  • Direct secure messaging: dbobovnyik16894@direct.bsmhealth.org

Organizations & group practices 4

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 3

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": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476835200000",
    "number": "1902876964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3660 STUTZ DR",
            "address_2": "STE 102",
            "city": "CANFIELD",
            "state": "OH",
            "postal_code": "444068149",
            "telephone_number": "330-702-1585",
            "fax_number": "330-702-1383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3660 STUTZ DR",
            "address_2": "STE 102",
            "city": "CANFIELD",
            "state": "OH",
            "postal_code": "444068149",
            "telephone_number": "330-702-1585",
            "fax_number": "330-702-1383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOBOVNYIK",
        "first_name": "DENISE",
        "middle_name": "LOUISE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-24",
        "last_updated": "2016-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35054533",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "H153520",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0703368",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canfield, OH

Sources for this page

Verify at the official NPI Registry.