NPIMap

Organization Active NPI

Marymount Primary Care Services, Inc.

  • Family Medicine Physician
  • Broadview Heights, OH
National Provider Identifier
1063606440
Registry record updated May 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MARYMOUNT PRIMARY CARE SERVICES, INC.
Practice address
2001 E Royalton Rd
Broadview Heights, OH 44147-2811
Phone
(440) 717-6100
Fax
(440) 546-1382
NPI assigned
Aug 29, 2007
Last updated
May 27, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2008

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

Authorized official

Name
Peter P Walchanowicz
Title
Practice Manager
Phone
(440) 543-8855

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

2001 E Royalton Rd
Broadview Heights, OH 44147-2811

Mailing address

2001 E Royalton Rd
Broadview Heights, OH 44147-2811
Phone (440) 717-6100

Other identifiers 2

IdentifierTypeStateIssuer
2082160MedicaidOH
000000564045OtherOHANTHEM

National Provider Directory

National Provider Directory

Locations

2001 E Royalton Rd
Broadview Hts, OH 44147
Phone (440) 717-5800

12000 McCracken Rd
Ste 107
Garfield Hts, OH 44125
Phone (216) 332-0920

12000 McCracken Rd
Ste 109
Garfield Hts, OH 44125
Phone (216) 663-1181

12000 McCracken Rd
Ste 211
Garfield Hts, OH 44125
Phone (216) 587-4600

12000 McCracken Rd
Ste 558
Garfield Hts, OH 44125
Phone (216) 581-8369

4400 Rockside Rd
Ste 2100
Independence, OH 44131
Phone (216) 328-8911

8936 Darrow Rd
Twinsburg, OH 44087
Phone (330) 405-4850

Practitioners & affiliated clinicians

Practitioners 8

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": "1188345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211846400000",
    "number": "1063606440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 E ROYALTON RD",
            "city": "BROADVIEW HEIGHTS",
            "state": "OH",
            "postal_code": "441472811",
            "telephone_number": "440-717-6100",
            "fax_number": "440-546-1382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 E ROYALTON RD",
            "city": "BROADVIEW HEIGHTS",
            "state": "OH",
            "postal_code": "441472811",
            "telephone_number": "440-717-6100",
            "fax_number": "440-546-1382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYMOUNT PRIMARY CARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-29",
        "last_updated": "2008-05-27",
        "status": "A",
        "authorized_official_last_name": "WALCHANOWICZ",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "440-543-8855"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2082160",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000564045",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Broadview Heights, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2008; 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.