NPIMap

Organization Active NPI

Case Dental Medicine Support Services, LLC.

  • Oral and Maxillofacial Surgery (Dentist)
  • Cleveland, OH
National Provider Identifier
1104059658
Registry record updated Jun 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
CASE DENTAL MEDICINE SUPPORT SERVICES, LLC.
Practice address
9601 Chester Ave
Suite 154
Cleveland, OH 44106-1666
Phone
(216) 368-3102
Fax
(216) 368-4338
NPI assigned
Sep 1, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2021

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

Authorized official

Name
Mr. Dale A. Baur Sr., DDSNPI 1245218544
Title
Department Chair
Phone
(216) 368-3102

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X OH Primary

Addresses

Primary practice location

9601 Chester Ave
Suite 154
Cleveland, OH 44106-1666

Mailing address

P.O. Box 415
Chesterland, OH 44026-0415
Phone (440) 729-3399

Other identifiers 1

IdentifierTypeStateIssuer
301960MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100825001171 OH Part B Supplier - Clinic/Group Practice 7416071592 Receives reassigned benefits from 8 practitioners
Practice locations: Cleveland, OH

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

8140 Mayfield Rd
Ste 2
Chesterland, OH 44026

9601 Chester Ave
Cleveland, OH 44106
Phone (216) 368-3102

9601 Chester Ave
Ste 154
Cleveland, OH 44106
Phone (216) 368-3102

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1251763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624320000000",
    "number": "1104059658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 415",
            "city": "CHESTERLAND",
            "state": "OH",
            "postal_code": "440260415",
            "telephone_number": "440-729-3399",
            "fax_number": "440-729-6001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9601 CHESTER AVE",
            "address_2": "SUITE 154",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441061666",
            "telephone_number": "216-368-3102",
            "fax_number": "216-368-4338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CASE DENTAL MEDICINE SUPPORT SERVICES, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-01",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A",
        "authorized_official_last_name": "BAUR",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "DEPARTMENT CHAIR",
        "authorized_official_telephone_number": "216-368-3102",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "301960",
            "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 Jun 22, 2021; 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.