NPIMap

Individual provider Active NPI

Kim Anne Delisio, NP

  • Adult Health Nurse Practitioner
  • Willoughby, OH
National Provider Identifier
1972737443
Registry record updated Nov 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
10639-NP Issued in OH
Practice address
36000 Euclid Ave
Anticoagulation Clinic
Willoughby, OH 44094-4625
Phone
(440) 953-9600
Fax
(440) 953-6037
NPI assigned
May 12, 2009
Last updated
Nov 9, 2009By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 10639-NP OH Primary

Addresses

Primary practice location

36000 Euclid Ave
Anticoagulation Clinic
Willoughby, OH 44094-4625

Mailing address

36000 Euclid Ave
Anticoagulation Clinic
Willoughby, OH 44094-4625
Phone (440) 953-9600

Other names 1

  • Mrs. Kim Anne Attina Other name

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
I20091016000399 OH Practitioner - Nurse Practitioner 3971640301 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lake Hospital System, Inc.Group PAC ID 6002713922, 92 clinicians

Practice addresses (Care Compare)

36500 Euclid Ave
Willoughby, OH 44094-4455
Phone (440) 516-0530

9485 Mentor Ave
Mentor, OH 44060-8723

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
10639-NPOHMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University Hospitals Medical Group Inc CurrentSince Jan 1, 2023 Accepting new patients
Lake Hospital System Inc. CurrentSince Apr 27, 2015 Accepting new patients
Lake Hospital System Inc Current Accepting new patients
Lake Hospital System Inc. Adult Health Past Accepting new patients
Lake Hospital System Past Accepting new patients

Locations

11100 Euclid Ave
Cleveland Heights, OH 44106

7590 Auburn Rd
Concord Township, OH 44077
Phone (440) 354-1899

36000 Euclid Ave
Willoughby Hills, OH 44094
Phone (440) 375-8166

Interoperability endpoints

  • Direct secure messaging: kdelisio28266@ehrdirect.uhhospitals.org

Organizations & group practices 5

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 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": "1242086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257724800000",
    "number": "1972737443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36000 EUCLID AVE",
            "address_2": "ANTICOAGULATION CLINIC",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440944625",
            "telephone_number": "440-953-9600",
            "fax_number": "440-953-6037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36000 EUCLID AVE",
            "address_2": "ANTICOAGULATION CLINIC",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440944625",
            "telephone_number": "440-953-9600",
            "fax_number": "440-953-6037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELISIO",
        "first_name": "KIM",
        "middle_name": "ANNE",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-12",
        "last_updated": "2009-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OH",
            "license": "10639-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "ATTINA",
            "middle_name": "ANNE",
            "prefix": "MRS.",
            "credential": "NP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Willoughby, OH

Sources for this page

Verify at the official NPI Registry.