NPIMap

Organization Active NPI

CDC Physicians Organization, Inc.

  • Nephrology Physician
  • Shaker Heights, OH
National Provider Identifier
1073682209
Registry record updated Mar 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
35081307 Issued in OH
Legal business name
CDC PHYSICIANS ORGANIZATION, INC.
Practice address
18720 Chagrin Blvd
Shaker Heights, OH 44122-4855
Phone
(216) 295-7003
Fax
(216) 295-7014
NPI assigned
Nov 6, 2006
Last updated
Mar 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2025

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

Authorized official

Name
Gayle A Nemecek
Title
Coo
Phone
(216) 658-0458

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 35081307 OH Primary
Vascular & Interventional Radiology Physician 2085R0204X 35062206 OH

Addresses

Primary practice location

18720 Chagrin Blvd
Shaker Heights, OH 44122-4855

Mailing address

18720 Chagrin Blvd
Shaker Heights, OH 44122-4855
Phone (216) 295-7003

Other identifiers 1

IdentifierTypeStateIssuer
2329126MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070827000000 OH Part B Supplier - Clinic/Group Practice 8426140187 Receives reassigned benefits from 12 practitioners
Practice locations: Westlake, OH; Orange Village, OH; Cleveland, OH; Fairview Park, OH; Beachwood, OH

National Provider Directory

National Provider Directory

Locations

3619 Park East Dr
Ste 318S
Beachwood, OH 44122
Phone (216) 896-0639

24651 Center Ridge Rd
Ste 450
Westlake, OH 44145
Phone (440) 471-8308

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740960000000",
    "number": "1073682209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18720 CHAGRIN BLVD",
            "city": "SHAKER HEIGHTS",
            "state": "OH",
            "postal_code": "441224855",
            "telephone_number": "216-295-7003",
            "fax_number": "216-295-7014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18720 CHAGRIN BLVD",
            "city": "SHAKER HEIGHTS",
            "state": "OH",
            "postal_code": "441224855",
            "telephone_number": "216-295-7003",
            "fax_number": "216-295-7014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CDC PHYSICIANS ORGANIZATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A",
        "authorized_official_last_name": "NEMECEK",
        "authorized_official_first_name": "GAYLE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "216-658-0458"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "OH",
            "license": "35081307",
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "OH",
            "license": "35062206",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2329126",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shaker Heights, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2025; 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.