Organization Active NPI

Cheviot Medical Center Inc

  • Internal Medicine Physician
  • Cincinnati, OH
National Provider Identifier
1063532430
Registry record updated Jul 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35-073706 Issued in OH
Legal business name
CHEVIOT MEDICAL CENTER INC
Practice address
3502 Boudinot Ave
Cincinnati, OH 45211-5726
Phone
(513) 481-9100
Fax
(513) 389-7052
NPI assigned
Mar 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2010

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

Authorized official

Name
Dr. Srilakshmi L Pisati, M.D.NPI 1265494447
Title
Owner
Phone
(513) 481-9100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 35-073706 OH Primary

Addresses

Primary practice location

3502 Boudinot Ave
Cincinnati, OH 45211-5726

Mailing address

3502 Boudinot Ave
Cincinnati, OH 45211-5726
Phone (513) 481-9100

Other identifiers 1

IdentifierTypeStateIssuer
2119139MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050111000059 OH Part B Supplier - Clinic/Group Practice 6406804087 Receives reassigned benefits from 1 practitioner
Practice locations: Cincinnati, OH

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D0902987Cheviot Medical Center3502 Boudinot Avenue, Cincinnati, OH 45211Certificate of waiverJul 9, 2027

National Provider Directory

National Provider Directory

Locations

3502 Boudinot Ave
Cincinnati, OH 45211
Phone (513) 481-9100

Practitioners & affiliated clinicians

Practitioners 3

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": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279670400000",
    "number": "1063532430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3502 BOUDINOT AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452115726",
            "telephone_number": "513-481-9100",
            "fax_number": "513-389-7052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3502 BOUDINOT AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452115726",
            "telephone_number": "513-481-9100",
            "fax_number": "513-389-7052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHEVIOT MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2010-07-21",
        "status": "A",
        "authorized_official_last_name": "PISATI",
        "authorized_official_first_name": "SRILAKSHMI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "513-481-9100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35-073706",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2119139",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.