Active NPI
Jeanette Porubovich-Mizenko, MD
- Internal Medicine Physician
- Akron, OH
National Provider Identifier
1942285218
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 35-05-5955-P
- Practice address
- 55 W Waterloo Rd
Akron, OH 44319-1116 - Phone
- (330) 724-7715
- NPI assigned
- Dec 9, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 35-05-5955-P | OH | Primary |
Addresses
Primary practice location
55 W Waterloo Rd
Akron, OH 44319-1116
Mailing address
PO Box 30076
Cleveland, OH 44130-0076
Phone (440) 816-5379
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2238206 | Medicaid | OH | |
| CN3937 | Other | OH | RAILROAD MEDICARE GROUP |
| 2228330 | Other | OH | AETNA |
| 000000028998 | Other | OH | ANTHEM |
| 0935420 | Medicaid | OH | |
| 80207 | Other | OH | QUAL CHOICE |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121008000429 | OH | Order and Referring Only - Internal Medicine | 8729072707 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346716800000",
"number": "1942285218",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 30076",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441300076",
"telephone_number": "440-816-5379"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 W WATERLOO RD",
"city": "AKRON",
"state": "OH",
"postal_code": "443191116",
"telephone_number": "330-724-7715"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORUBOVICH-MIZENKO",
"first_name": "JEANETTE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-09",
"last_updated": "2012-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "OH",
"license": "35-05-5955-P",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2238206",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE GROUP",
"identifier": "CN3937",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "2228330",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000028998",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0935420",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "QUAL CHOICE",
"identifier": "80207",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Akron, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2012; 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.