Active NPI
Mary Ann Murphy Colegrove, R.D, L.D.
- Registered Dietitian
- South Euclid, OH
National Provider Identifier
1063662815
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD5178
- Practice address
- 1611 S Green Rd
Suite 202
South Euclid, OH 44121-4128 - Phone
- (216) 381-4541
- NPI assigned
- Sep 29, 2008
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | LD5178 | OH | Primary |
Addresses
Primary practice location
1611 S Green Rd
Suite 202
South Euclid, OH 44121-4128
Mailing address
10140 Andover Dr
Twinsburg, OH 44087-3324
Phone (216) 798-6137
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LD5178 | OH | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tanya Sussman Rd, LLC | Dietitian, Registered | Past | Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/21616/brand/1/csg/1/fhir/r4
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222646400000",
"number": "1063662815",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10140 ANDOVER DR",
"city": "TWINSBURG",
"state": "OH",
"postal_code": "440873324",
"telephone_number": "216-798-6137"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1611 S GREEN RD",
"address_2": "SUITE 202",
"city": "SOUTH EUCLID",
"state": "OH",
"postal_code": "441214128",
"telephone_number": "216-381-4541"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLEGROVE",
"first_name": "MARY ANN",
"middle_name": "MURPHY",
"name_prefix": "Mrs.",
"credential": "R.D, L.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-09-29",
"last_updated": "2008-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OH",
"license": "LD5178",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Euclid, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 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.