Individual provider Active NPI

Laura J. Riley, CNP

  • Nurse Practitioner
  • Canton, OH
National Provider Identifier
1972870194
Registry record updated Jun 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
COA-12683-NP Issued in OH
Practice address
2600 7TH St SW
Canton, OH 44710-1709
Phone
(330) 363-6242
Fax
(330) 363-3877
NPI assigned
Nov 17, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X COA-12683-NP OH Primary

Addresses

Primary practice location

2600 7TH St SW
Canton, OH 44710-1709

Mailing address

The Univ of Akron NSG Center MGH # 116
209 Carroll Street
Akron, OH 44325-3703
Phone (330) 972-6968

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111207000760 OH Practitioner - Nurse Practitioner 2466627153 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
My Community Health CenterGroup PAC ID 3971884636, 27 clinicians

Practice addresses (Care Compare)

2600 7TH St SW
Canton, OH 44710-1709
Phone (330) 363-6242

Hospital & facility affiliations

  • Aultman Hospital Hospital, Canton, OH, CCN 360084

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
COA-12683-NPOHMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
My Community Health Center CurrentSince Jan 7, 2018 Accepting new patients
My Community Health Center CurrentSince Jan 7, 2018 Accepting new patients
My Community Health Center Past Accepting new patients

Locations

2600 7th St SW
Canton, OH 44710
Phone (330) 363-6242

10029 Cleveland Ave SE
Magnolia, OH 44643
Phone (234) 386-0306

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1321488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592784000000",
    "number": "1972870194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "THE UNIV OF AKRON NSG CENTER MGH # 116",
            "address_2": "209 CARROLL STREET",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "443253703",
            "telephone_number": "330-972-6968",
            "fax_number": "330-972-5883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 7TH ST SW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447101709",
            "telephone_number": "330-363-6242",
            "fax_number": "330-363-3877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RILEY",
        "first_name": "LAURA",
        "middle_name": "J.",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-17",
        "last_updated": "2020-06-22",
        "certification_date": "2020-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "COA-12683-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, OH

Sources for this page

Verify at the official NPI Registry.