City of Cincinnati

Primary specialty

Public Health DentistryTaxonomy code 1223D0001X

Legal business name

CITY OF CINCINNATI

Practice address

612 Rockdale Ave
Cincinnati, OH 45229-2919

Phone

(513) 352-4072

Fax

(513) 352-4075

NPI assigned

Jan 26, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Noble Maseru, PH.D, MPH

Title

Health Commissioner

Phone

(513) 357-7280

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Federally qualified health center certification: CCN 361958

Legal name

CITY OF CINCINNATI

Doing business as

CREST SMILE SHOPPE

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Oct 29, 2009

Last certification

Oct 29, 2009

Ownership / control type

For profit – corporation

Organization structure

GovernmentNon-profit

Enrollment address

612 Rockdale Ave
Cincinnati, OH 45229-2919

Other NPIs on the same Medicare enrollment 1

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

• City of Cincinnati

  • Federally Qualified Health Center (FQHC)
  • Cincinnati, OH
  • NPI 1245553965

  O20090922000686

  Same enrollment

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266969600000",
    "number": "1013063429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3101 BURNET AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452293014",
            "telephone_number": "513-357-7289",
            "fax_number": "513-357-7396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 ROCKDALE AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452292919",
            "telephone_number": "513-352-4072",
            "fax_number": "513-352-4075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF CINCINNATI",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2010-02-24",
        "status": "A",
        "authorized_official_last_name": "MASERU",
        "authorized_official_first_name": "NOBLE",
        "authorized_official_title_or_position": "HEALTH COMMISSIONER",
        "authorized_official_telephone_number": "513-357-7280",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D, MPH"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Dental Public Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "O184652",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cisse Enterprise LLC
• David Citron
• Michael Joseph Cittadino, CNP
• City Dermatology and Laser
• City of Cheviot Auditor
• City of Cincinnati
• City of Cincinnati
• City of Cincinnati
• City of Cincinnati
• City of Cincinnati

• Public Health Dentistry in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Public Health Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.