Main Street Medical Group, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

35-06-0015 Issued in OH

Legal business name

MAIN STREET MEDICAL GROUP, LLC

Practice address

7190 Cottesmore LN
Solon, OH 44139-4702

Phone

(440) 349-1983

Fax

(440) 349-1983

NPI assigned

Mar 21, 2008

Last updated

Aug 18, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Randall Scott Schwartz, M.D.NPI 1629093729

Title

Proprietor

Phone

(440) 946-4662

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Locations

Practitioners 4

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.

• Randall Scott Schwartz, M.D.

  • Internal Medicine Physician
  • Solon, OH
  • NPI 1629093729
  Medicare reassignment NPD Authorized official
• Yelena Bogatello, AGPCNP, NP-C

  • Nurse Practitioner
  • Mayfield HTS, OH
  • NPI 1407198914
  Medicare reassignment NPD
• Matthew Dvorak

  • Adult Health Nurse Practitioner
  • Cleveland, OH
  • NPI 1578977518
  Medicare reassignment NPD
• Dolores A Nelson, CNP

  • Nurse Practitioner
  • Willoughby, OH
  • NPI 1801849005
  Medicare reassignment

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

{
    "created_epoch": "1206057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692316800000",
    "number": "1063683662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36001 EUCLID AVE",
            "address_2": "C-17",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440944643",
            "telephone_number": "440-946-4662",
            "fax_number": "440-946-4084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7190 COTTESMORE LN",
            "city": "SOLON",
            "state": "OH",
            "postal_code": "441394702",
            "telephone_number": "440-349-1983",
            "fax_number": "440-349-1983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-21",
        "last_updated": "2023-08-18",
        "certification_date": "2023-08-18",
        "status": "A",
        "authorized_official_last_name": "SCHWARTZ",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "PROPRIETOR",
        "authorized_official_telephone_number": "440-946-4662",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35-06-0015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2817321",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE SHIELD",
            "identifier": "000000562822",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Solon, OH
• Providers in Solon, OH by specialty
• Internal Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 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.