NPIMap

Organization Active NPI

Premise Health of Ohio Medical, P.a

Doing business as LIving Well Health Center

  • Primary Care Clinic/Center
  • Redmond, WA
National Provider Identifier
1063770196
Registry record updated Aug 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
PREMISE HEALTH OF OHIO MEDICAL, P.A
Doing business as
LIving Well Health Center
Practice address
3925 159TH Ave NE
Redmond, WA 98052-6309
Phone
(425) 216-0550
Fax
(425) 216-0551
NPI assigned
Apr 26, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2022

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

Authorized official

Name
Jon Leizman, M.D.
Title
President
Phone
(216) 479-9063

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

3925 159TH Ave NE
Redmond, WA 98052-6309

Mailing address

5500 Maryland Way
Brentwood, TN 37027-4948
Phone (877) 865-9013

Other names 1

  • LIving Well Health Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Premise Health of Ohio Medical PA45 organizations share this tax ID, including this one

Other organizations with this tax ID 44

Organizations that report the same tax identification number in the National Provider Directory.

View all 44

Locations

3925 159th Ave NE
Redmond, WA 98052
Phone (425) 216-0550

NPI Registry JSON

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

{
    "created_epoch": "1335398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660608000000",
    "number": "1063770196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MARYLAND WAY",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274948",
            "telephone_number": "877-865-9013",
            "fax_number": "425-216-0551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3925 159TH AVE NE",
            "city": "REDMOND",
            "state": "WA",
            "postal_code": "980526309",
            "telephone_number": "425-216-0550",
            "fax_number": "425-216-0551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH OF OHIO MEDICAL, P.A",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-26",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A",
        "authorized_official_last_name": "LEIZMAN",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "216-479-9063",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LIving Well Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LIving Well Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Redmond, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; 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.