NPIMap

Organization Active NPI

Ohio Permanente Medical Group

Doing business as Kaiser Permanente

  • Internal Medicine Physician
  • Medina, OH
National Provider Identifier
1073882445
Registry record updated Dec 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
OHIO PERMANENTE MEDICAL GROUP
Doing business as
Kaiser Permanente
Practice address
3443 Medina Rd
Suite 108
Medina, OH 44256-5360
Phone
(216) 265-8844
Fax
(216) 265-8890
NPI assigned
Dec 14, 2011
Last updated
Dec 14, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2011

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

Authorized official

Name
Mr. Craig Faerber
Title
VP/Cfo
Phone
(216) 265-8844

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OH Primary
Pediatrics Physician 208000000X OH

Addresses

Primary practice location

3443 Medina Rd
Suite 108
Medina, OH 44256-5360

Mailing address

12301 Snow Rd
Parma, OH 44130-1002
Phone (216) 265-8844

Other identifiers 1

IdentifierTypeStateIssuer
0211372MedicaidOH

Other names 1

  • Kaiser Permanente Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Kaiser Permanente16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1323820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323820800000",
    "number": "1073882445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12301 SNOW RD",
            "city": "PARMA",
            "state": "OH",
            "postal_code": "441301002",
            "telephone_number": "216-265-8844",
            "fax_number": "216-265-8890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3443 MEDINA RD",
            "address_2": "SUITE 108",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442565360",
            "telephone_number": "216-265-8844",
            "fax_number": "216-265-8890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OHIO PERMANENTE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-14",
        "last_updated": "2011-12-14",
        "status": "A",
        "authorized_official_last_name": "FAERBER",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "VP/CFO",
        "authorized_official_telephone_number": "216-265-8844",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0211372",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kaiser Permanente",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Medina, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2011; 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.