NPIMap

Organization Active NPI

Firelands Regional Medical Center Family Practice Clinic

  • Primary Care Clinic/Center
  • Sandusky, OH
National Provider Identifier
1083896773
Registry record updated Dec 4, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
FIRELANDS REGIONAL MEDICAL CENTER FAMILY PRACTICE CLINIC
Practice address
1912 Hayes Ave
Sandusky, OH 44870-4736
Phone
(419) 557-7184
Fax
(419) 557-7109
NPI assigned
Dec 4, 2007
Last updated
Dec 4, 2007By the provider in NPPES
Organization subpart
Yes
Parent organization
FIRELANDS REGIONAL MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 4, 2007

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

Authorized official

Name
Mrs. Sandie Beal, RN
Title
Director, Managed Practices
Phone
(419) 557-5126

Specialties & licenses 1

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

Addresses

Primary practice location

1912 Hayes Ave
Sandusky, OH 44870-4736

Mailing address

1912 Hayes Ave
Sandusky, OH 44870-4736
Phone (419) 557-7184

Other identifiers 1

IdentifierTypeStateIssuer
2368272MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040415000236 OH Part B Supplier - Clinic/Group Practice 6103734645 Receives reassigned benefits from 36 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sandusky, OH

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Firelands Comm Hosp

NPI Registry JSON

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

{
    "created_epoch": "1196726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196726400000",
    "number": "1083896773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1912 HAYES AVE",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448704736",
            "telephone_number": "419-557-7184",
            "fax_number": "419-557-7109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1912 HAYES AVE",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448704736",
            "telephone_number": "419-557-7184",
            "fax_number": "419-557-7109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRELANDS REGIONAL MEDICAL CENTER FAMILY PRACTICE CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FIRELANDS REGIONAL MEDICAL CENTER",
        "enumeration_date": "2007-12-04",
        "last_updated": "2007-12-04",
        "status": "A",
        "authorized_official_last_name": "BEAL",
        "authorized_official_first_name": "SANDIE",
        "authorized_official_title_or_position": "DIRECTOR, MANAGED PRACTICES",
        "authorized_official_telephone_number": "419-557-5126",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2368272",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandusky, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2007; 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.