Active NPI
Dori J Supan, LISW
- Psychiatry Physician
- Beachwood, OH
National Provider Identifier
1063526846
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- I002766
- Practice address
- 24400 Highpoint Rd
Ste 6
Beachwood, OH 44122 - Phone
- (216) 831-6550
- Fax
- (216) 831-6133
- NPI assigned
- Aug 18, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | I002766 | OH | Primary |
Addresses
Primary practice location
24400 Highpoint Rd
Ste 6
Beachwood, OH 44122
Mailing address
24400 Highpoint Rd
Ste 6
Beachwood, OH 44122
Phone (216) 831-6550
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1975
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
19035 Old Detroit Rd
Suite 209
Rocky River, OH 44116-1750
Phone (216) 831-6550
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| I002766 | OH | MD | Psychiatry Physician |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Psychiatry Physician
- Beachwood, OH
- NPI 1740393545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063526846",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24400 HIGHPOINT RD",
"address_2": "STE 6",
"city": "BEACHWOOD",
"state": "OH",
"postal_code": "44122",
"telephone_number": "216-831-6550",
"fax_number": "216-831-6133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24400 HIGHPOINT RD",
"address_2": "STE 6",
"city": "BEACHWOOD",
"state": "OH",
"postal_code": "44122",
"telephone_number": "216-831-6550",
"fax_number": "216-831-6133"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUPAN",
"first_name": "DORI",
"middle_name": "J",
"name_prefix": "Mrs.",
"credential": "LISW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "OH",
"license": "I002766",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beachwood, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.