NPIMap

Organization Active NPI

St Augustine Manor

  • Gerontology Nurse Practitioner
  • Cleveland, OH
National Provider Identifier
1033599105
Registry record updated Jun 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
Legal business name
ST AUGUSTINE MANOR
Practice address
7801 Detroit Ave
Cleveland, OH 44102-2813
Phone
(216) 634-7400
Fax
(216) 634-7483
NPI assigned
Jun 4, 2015
Last updated
Jun 4, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
ST AUGUSTINE MANORAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 4, 2015

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

Authorized official

Name
Mr. Francis S Huba
Title
Chief Financial Officer
Phone
(216) 634-7555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X NU Primary

Addresses

Primary practice location

7801 Detroit Ave
Cleveland, OH 44102-2813

Mailing address

7801 Detroit Ave
Cleveland, OH 44102-2813
Phone (216) 634-7400

Other names 1

  • ST AUGUSTINE MANOR PROFESSIONAL SERVICES Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150807013733 OH Part B Supplier - Clinic/Group Practice 6709808116 Receives reassigned benefits from 12 practitioners
Practice locations: Cleveland, OH

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
St Augustine Manor Corp4 organizations share this tax ID, including this one
Part of
St Augustine Manor Corp

Other organizations with this tax ID 3

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

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Holy Family HospiceParma, OH, CCN 361631 Hospice 5% Or Greater Direct Ownership Interest (100%) Oct 13, 2005

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • St Augustine Manor

    dba St Augustine Manor doing business as Holy Family Hospice

    • Community Based Hospice Care Agency
    • Parma, OH
    • NPI 1376667014

    5% Or Greater Direct Ownership Interest

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1433376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433376000000",
    "number": "1033599105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7801 DETROIT AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441022813",
            "telephone_number": "216-634-7400",
            "fax_number": "216-634-7483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7801 DETROIT AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441022813",
            "telephone_number": "216-634-7400",
            "fax_number": "216-634-7483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST AUGUSTINE MANOR",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST AUGUSTINE MANOR",
        "enumeration_date": "2015-06-04",
        "last_updated": "2015-06-04",
        "status": "A",
        "authorized_official_last_name": "HUBA",
        "authorized_official_first_name": "FRANCIS",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "216-634-7555",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ST AUGUSTINE MANOR PROFESSIONAL SERVICES",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.