NPIMap

Organization Active NPI

Vital Health LLC

  • Family Medicine Physician
  • Maumee, OH
National Provider Identifier
1003551052
Registry record updated Sep 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
VITAL HEALTH LLC
Practice address
111 Clinton St
Maumee, OH 43537-2811
Phone
(419) 740-3022
Fax
(419) 740-3033
NPI assigned
May 4, 2022
Organization subpart
Yes
Parent organization
VITAL HEALTH LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 29, 2023

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

Authorized official

Name
Nicole M Spellis-Freyre, CRNPNPI 1174034292
Title
Authorized Official
Phone
(419) 740-3022

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

111 Clinton St
Maumee, OH 43537-2811

Mailing address

111 Clinton St
Maumee, OH 43537-2811
Phone (419) 740-3022

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220303002103 OH Part B Supplier - Clinic/Group Practice 4486048634 Receives reassigned benefits from 6 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Maumee, OH

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Vital Health LLC3 organizations share this tax ID, including this one
Part of
Vital Health LLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1651622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695945600000",
    "number": "1003551052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 CLINTON ST",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435372811",
            "telephone_number": "419-740-3022",
            "fax_number": "419-740-3033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 CLINTON ST",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435372811",
            "telephone_number": "419-740-3022",
            "fax_number": "419-740-3033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITAL HEALTH LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VITAL HEALTH LLC",
        "enumeration_date": "2022-05-04",
        "last_updated": "2023-09-29",
        "certification_date": "2023-09-29",
        "status": "A",
        "authorized_official_last_name": "SPELLIS-FREYRE",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "419-740-3022",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maumee, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.