Organization Active NPI

Shoreway Family Practice Inc

  • Family Medicine Physician
  • Parma, OH
National Provider Identifier
1023155173
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35 040166 Issued in OH
Legal business name
SHOREWAY FAMILY PRACTICE INC
Practice address
6739 Ridge Road
Parma, OH 44129
Phone
(440) 887-9605
Fax
(440) 887-9606
NPI assigned
Jan 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Norberto L Juan, MD
Title
President
Phone
(440) 887-9605

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 35 040166 OH Primary

Addresses

Primary practice location

6739 Ridge Road
Parma, OH 44129

Mailing address

6739 Ridge Road
Parma, OH 44129
Phone (440) 887-9605

Other identifiers 1

IdentifierTypeStateIssuer
0335104MedicaidOH

National Provider Directory

National Provider Directory

Locations

11009 Detroit Ave
Cleveland, OH 44102
Phone (216) 228-1129

Practitioners & affiliated clinicians

Practitioners 2

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": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1023155173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6739 RIDGE ROAD",
            "city": "PARMA",
            "state": "OH",
            "postal_code": "44129",
            "telephone_number": "440-887-9605",
            "fax_number": "440-887-9606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6739 RIDGE ROAD",
            "city": "PARMA",
            "state": "OH",
            "postal_code": "44129",
            "telephone_number": "440-887-9605",
            "fax_number": "440-887-9606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOREWAY FAMILY PRACTICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JUAN",
        "authorized_official_first_name": "NORBERTO",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "440-887-9605",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35 040166",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0335104",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Parma, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.