NPIMap

Organization Active NPI

Great Health Medical Oh Inc

  • Family Medicine Physician
  • Wooster, OH
National Provider Identifier
1104630912
Registry record updated Dec 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GREAT HEALTH MEDICAL OH INC
Practice address
1552 N Honeytown Rd
Wooster, OH 44691-9511
Phone
(718) 470-0288
NPI assigned
Feb 3, 2025
Last updated
Dec 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2025

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

Authorized official

Name
Azlan TariqNPI 1528291283
Title
Owner
Phone
(312) 709-7238

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
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1552 N Honeytown Rd
Wooster, OH 44691-9511

Mailing address

407 Willoughby Ave
Brooklyn, NY 11205-4590

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250305003977 OH Part B Supplier - Clinic/Group Practice 1456872597 Receives reassigned benefits from 19 practitioners
Practice locations: Wooster, OH

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1738540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765324800000",
    "number": "1104630912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 WILLOUGHBY AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112054590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1552 N HONEYTOWN RD",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446919511",
            "telephone_number": "718-470-0288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT HEALTH MEDICAL OH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-03",
        "last_updated": "2025-12-10",
        "certification_date": "2025-12-10",
        "status": "A",
        "authorized_official_last_name": "TARIQ",
        "authorized_official_first_name": "AZLAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-709-7238"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wooster, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 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.