ANGELA MARIE KOGUT PAC
Complete NPI Record 1770657702
Physician Assistant in Fairlawn, OH
Active since November 20, 2006PECOS EnrolledAccepts Medicare Assignment
83.2/100
CMS Quality Rating
Complete NPI Dataset
This page contains the complete raw NPPES record for Angela Marie Kogut, PAC (NPI 1770657702), an individual physician assistant provider in Fairlawn, OH. All 28 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1770657702 Field 1/28
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 1 Field 2/28
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Provider Last Name Legal Name: KOGUT Field 3/28
- The last name of the provider. If the provider is an individual, this is the legal name.
- Provider First Name: ANGELA Field 4/28
- The first name of the provider, if the provider is an individual.
- Provider Middle Name: MARIE Field 5/28
- The middle name of the provider, if the provider is an individual.
- Provider Credential Text: PAC Field 6/28
- The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
- Provider First Line Business Mailing Address: 3801 SANTA ROSA DR Field 7/28
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: KINGMAN Field 8/28
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: AZ Field 9/28
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 864012311 Field 10/28
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 11/28
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 9287572101 Field 12/28
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider First Line Business Practice Location Address: 3535 S SMITH RD STE A Field 13/28
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: FAIRLAWN Field 14/28
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: OH Field 15/28
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 443339270 Field 16/28
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 17/28
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 3302082720 Field 18/28
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 3302082721 Field 19/28
- The fax number associated with the location address of the provider being identified.
- Provider Gender Code: F Field 22/28
- The code designating the provider's gender if the provider is a person.
- Healthcare Provider Taxonomy Code 1: 363A00000X Field 23/28
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 24/28
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Other Provider Identifier 1: 2259532 Field 25/28
- An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
- Other Provider Identifier Type Code 1: 05 Field 26/28
- A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
- Other Provider Identifier State 1: OH Field 27/28
- The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
- Is Sole Proprietor: N Field 28/28
- Indicates whether the provider is registered as a sole proprietor. This is a single-character code: "Y" means the provider operates as a sole proprietor, and "N" means they do not.
Secondary Practice Locations 5
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
9150 Market Square Dr
Location 1/5Streetsboro, OH 44241-4571 · Phone (330) 208-2720 · Fax (330) 208-2721
3780 Medina Rd Ste 110
Location 2/5Medina, OH 44256-9312 · Phone (330) 208-2720 · Fax (330) 208-2721
1560 Corporate Woods Pkwy
Location 3/5Uniontown, OH 44685-8730 · Phone (330) 208-2720 · Fax (330) 208-2721
185 Wadsworth Rd, Rundle Building
Location 4/5Wadsworth, OH 44281-9585 · Phone (330) 208-2720 · Fax (330) 208-2721
3051 Graham Rd
Location 5/5Stow, OH 44224-3654 · Phone (330) 208-2720 · Fax (330) 208-2721
Other Provider Identifiers 1
Legacy and payer-issued identifiers reported to the NPPES registry for this provider.
2259532 Medicaid
Identifier 1/1State: OH
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
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