NPIMap

Organization Active NPI

Bellevue Professional Services, Inc.

Doing business as Great lakes Physicians

  • Obstetrics & Gynecology Physician
  • Bellevue, OH
National Provider Identifier
1063481737
Registry record updated Oct 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
35068821 Issued in OH
Legal business name
BELLEVUE PROFESSIONAL SERVICES, INC.
Doing business as
Great lakes Physicians
Practice address
1400 W Main St
BLDG 1, Suite a
Bellevue, OH 44811-9429
Phone
(419) 483-2494
Fax
(419) 483-3224
NPI assigned
Mar 15, 2006
Last updated
Oct 23, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2023

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

Authorized official

Name
Tim Buit
Title
Ceo
Phone
(419) 483-4040

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35090068 OH
Family Medicine Physician 207Q00000X 34012014 OH
Obstetrics & Gynecology Physician 207V00000X 35068821 OH Primary
Obstetrics & Gynecology Physician 207V00000X 34009034 OH
Obstetrics & Gynecology Physician 207V00000X 35127940 OH
Orthopaedic Surgery Physician 207X00000X 34006462 OH

Addresses

Primary practice location

1400 W Main St
BLDG 1, Suite a
Bellevue, OH 44811-9429

Mailing address

PO Box 638775
Cincinnati, OH 45263-8775
Phone (800) 514-4390

Other identifiers 1

IdentifierTypeStateIssuer
2535377MedicaidOH

Other names 1

  • Great lakes Physicians Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040126000517 OH Part B Supplier - Clinic/Group Practice 3779485099 Receives reassigned benefits from 10 practitioners
Practice locations: Bellevue, OH

National Provider Directory

National Provider Directory

Locations

102 Commerce Park Dr
Ste C
Bellevue, OH 44811
Phone (419) 483-2494

102 Commerce Park Dr
Ste E
Bellevue, OH 44811
Phone (419) 484-5430

1400 W Main St
Ste A
Bellevue, OH 44811
Phone (419) 483-2494

1005 W McPherson Hwy
Clyde, OH 43410
Phone (419) 547-4285

105 W McPherson Hwy
Clyde, OH 43410

402 W McPherson Hwy
Clyde, OH 43410
Phone (419) 547-0340

Interoperability endpoints

  • Direct secure messaging: andreamoore@bpsoh.allscriptsdirect.net
  • Direct secure messaging: benjaminball@bpsoh.allscriptsdirect.net
  • Direct secure messaging: colemanclougherty@bpsoh.allscriptsdirect.net
  • Direct secure messaging: coreyfazio@bpsoh.allscriptsdirect.net
  • Direct secure messaging: dawnbova@bpsoh.allscriptsdirect.net
  • Direct secure messaging: gregorykarasik@bpsoh.allscriptsdirect.net
  • Direct secure messaging: jodischwab@bpsoh.allscriptsdirect.net
  • Direct secure messaging: kimberlycullen@bpsoh.allscriptsdirect.net
  • Direct secure messaging: lisaaichholz@bpsoh.allscriptsdirect.net
  • Direct secure messaging: marciabraun@bpsoh.allscriptsdirect.net
  • Direct secure messaging: marcnaderer@bpsoh.allscriptsdirect.net
  • Direct secure messaging: maxpavlock@bpsoh.allscriptsdirect.net
  • Direct secure messaging: nathanfogt@bpsoh.allscriptsdirect.net
  • Direct secure messaging: nathansamsa@bpsoh.allscriptsdirect.net
  • Direct secure messaging: peterhighlander@bpsoh.allscriptsdirect.net
  • Direct secure messaging: samuelross@bpsoh.allscriptsdirect.net
  • Direct secure messaging: shaikhfawwad@bpsoh.allscriptsdirect.net

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698019200000",
    "number": "1063481737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 638775",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452638775",
            "telephone_number": "800-514-4390",
            "fax_number": "440-808-3675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 W MAIN ST",
            "address_2": "BLDG 1, SUITE A",
            "city": "BELLEVUE",
            "state": "OH",
            "postal_code": "448119429",
            "telephone_number": "419-483-2494",
            "fax_number": "419-483-3224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELLEVUE PROFESSIONAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-15",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A",
        "authorized_official_last_name": "BUIT",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "419-483-4040"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35090068",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "34012014",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OH",
            "license": "35068821",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OH",
            "license": "34009034",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OH",
            "license": "35127940",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "OH",
            "license": "34006462",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2535377",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great lakes Physicians",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Great lakes Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bellevue, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 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.