NPIMap

Organization Active NPI

Family Statcare of Northeast Ohio, LLC

  • Nurse Practitioner
  • Wadsworth, OH
National Provider Identifier
1053565986
Registry record updated Mar 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
FAMILY STATCARE OF NORTHEAST OHIO, LLC
Practice address
175 Great Oaks TRL
Wadsworth, OH 44281-8712
Phone
(330) 336-3588
Fax
(330) 336-1328
NPI assigned
Nov 5, 2008
Last updated
Mar 26, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2015

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

Authorized official

Name
Ken Filbert
Title
Owner
Phone
(330) 416-6153

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU Primary

Addresses

Primary practice location

175 Great Oaks TRL
Wadsworth, OH 44281-8712

Mailing address

230 Quadral Dr
Suite B
Wadsworth, OH 44281-8376
Phone (330) 336-3280

Other identifiers 1

IdentifierTypeStateIssuer
2939511MedicaidOH

National Provider Directory

National Provider Directory

Locations

3688 Center Rd
Brunswick, OH 44212
Phone (330) 225-0202

275 Forest Meadows Dr
Medina, OH 44256
Phone (330) 722-8118

230 Quadral Dr
Ste B
Wadsworth, OH 44281
Phone (330) 336-2800

629 Beall Ave
Wooster, OH 44691
Phone (330) 264-8404

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1225843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427328000000",
    "number": "1053565986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 QUADRAL DR",
            "address_2": "SUITE B",
            "city": "WADSWORTH",
            "state": "OH",
            "postal_code": "442818376",
            "telephone_number": "330-336-3280",
            "fax_number": "330-336-5325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 GREAT OAKS TRL",
            "city": "WADSWORTH",
            "state": "OH",
            "postal_code": "442818712",
            "telephone_number": "330-336-3588",
            "fax_number": "330-336-1328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY STATCARE OF NORTHEAST OHIO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-05",
        "last_updated": "2015-03-26",
        "status": "A",
        "authorized_official_last_name": "FILBERT",
        "authorized_official_first_name": "KEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "330-416-6153"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2939511",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wadsworth, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2015; 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.