Active NPI
Dale Edward Bates, MPAS PA-C
- Medical Physician Assistant
- Cleveland, OH
National Provider Identifier
1093871923
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 50.000692
- Practice address
- 1001 Lakeside Ave E
Suite 1000
Cleveland, OH 44114-1158 - Phone
- (440) 479-5349
- Fax
- (216) 420-9354
- NPI assigned
- Dec 28, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 50.000692 | OH | Primary |
Addresses
Primary practice location
1001 Lakeside Ave E
Suite 1000
Cleveland, OH 44114-1158
Mailing address
36385 Sandy Knoll Dr
Eastlake, OH 44095-5407
Phone (440) 479-5349
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 50.000692 | Other | OH | OHIO STATE LICENSE |
| 1026099 | Other | OH | NATIONAL NCCPA # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50.000692 | OH | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Optum Care Services Company | Medical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1093871923",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "36385 SANDY KNOLL DR",
"city": "EASTLAKE",
"state": "OH",
"postal_code": "440955407",
"telephone_number": "440-479-5349",
"fax_number": "440-953-0322"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 LAKESIDE AVE E",
"address_2": "SUITE 1000",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441141158",
"telephone_number": "440-479-5349",
"fax_number": "216-420-9354"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BATES",
"first_name": "DALE",
"middle_name": "EDWARD",
"name_prefix": "Mr.",
"credential": "MPAS PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "OH",
"license": "50.000692",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OHIO STATE LICENSE",
"identifier": "50.000692",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL NCCPA #",
"identifier": "1026099",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.