NPIMap

Organization Active NPI

Cityblock Medical Practice, LLC

  • Primary Care Clinic/Center
  • Columbus, OH
National Provider Identifier
1013673821
Registry record updated Jan 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
CITYBLOCK MEDICAL PRACTICE, LLC
Practice address
6100 E Main St Ste 110
Columbus, OH 43213-3399
Phone
(833) 904-0620
NPI assigned
Nov 16, 2021
Last updated
Jan 19, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2023

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

Authorized official

Name
Susan Brown
Title
Chief Administrative Officer
Phone
(833) 904-0620

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

6100 E Main St Ste 110
Columbus, OH 43213-3399

Mailing address

495 Flatbush Ave Ste C5
Brooklyn, NY 11225-3706

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220913000283 OH Part B Supplier - Clinic/Group Practice 4688059645 Receives reassigned benefits from 78 practitioners
Practice locations: Cincinnati, OH; Columbus, OH

National Provider Directory

National Provider Directory

Locations

4400 Easton Cmns
Ste 125
Columbus, OH 43219
Phone (855) 679-2366

500 E Main St
Ste 105
Columbus, OH 43215
Phone (614) 695-5060

800 N High St
Ste 4102
Columbus, OH 43215
Phone (347) 463-5529

Practitioners & affiliated clinicians

Practitioners 81

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 81

NPI Registry JSON

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

{
    "created_epoch": "1637020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674086400000",
    "number": "1013673821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "495 FLATBUSH AVE STE C5",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112253706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6100 E MAIN ST STE 110",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432133399",
            "telephone_number": "833-904-0620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITYBLOCK MEDICAL PRACTICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-16",
        "last_updated": "2023-01-19",
        "certification_date": "2023-01-19",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "833-904-0620"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 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.