Individual provider Active NPI

Veronica Ann Pankuch

  • Psychiatric/Mental Health Nurse Practitioner
  • Cleveland, OH
National Provider Identifier
1992401194
Registry record updated Jan 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
APRN.CNP.0033139 Issued in OH
Practice address
12201 Euclid Ave
Cleveland, OH 44106-4310
Phone
(216) 721-4010
NPI assigned
Jan 31, 2023
Last updated
Jan 31, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X APRN.CNP.0033139 OH Primary

Addresses

Primary practice location

12201 Euclid Ave
Cleveland, OH 44106-4310

Mailing address

8104 Ivandale Dr
Parma, OH 44129-4312
Phone (330) 801-1678

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
I20231208000297 OH Practitioner - Nurse Practitioner 3577912112 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Circle Health Services CurrentSince Sep 24, 2023 Accepting new patients
Circle Health Services CurrentSince Sep 24, 2023 Accepting new patients
Circle Health Services Past Accepting new patients
Circle Health Services Past Accepting new patients

Locations

4500 Euclid Ave
Cleveland, OH 44103
Phone (216) 325-9404

12201 Euclid Ave
Cleveland, OH 44106
Phone (216) 373-2846

5209 Detroit Ave
Cleveland, OH 44102
Phone (216) 651-2037

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.

NPI Registry JSON

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

{
    "created_epoch": "1675123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675123200000",
    "number": "1992401194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8104 IVANDALE DR",
            "city": "PARMA",
            "state": "OH",
            "postal_code": "441294312",
            "telephone_number": "330-801-1678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12201 EUCLID AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441064310",
            "telephone_number": "216-721-4010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANKUCH",
        "first_name": "VERONICA",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-31",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "APRN.CNP.0033139",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.