SHC Youngstown Ohio Outpatient Services LLC

Primary specialty

Urgent Care Clinic/CenterTaxonomy code 261QU0200X

Legal business name

SHC YOUNGSTOWN OHIO OUTPATIENT SERVICES LLC

Doing business as

Urgent Care Austintown

Practice address

20 Ohltown Rd
Austintown, OH 44515-2331

Phone

(330) 884-1500

NPI assigned

Apr 10, 2017

Organization subpart

No

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

Authorized official

Name

Mark Rich

Title

Officer / Director

Phone

(330) 884-1500

Specialties & licenses 1

Addresses

Other names 1

• Urgent Care Austintown Doing business as

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/15594/brand/2/csg/23/fhir/r4

Practitioners 4

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

• Tia Michelle Crisp, MSN, APRN, FNP-C

  • Primary Care Nurse Practitioner
  • Austintown, OH
  • NPI 1487281929
  Medicare reassignment
• Roman Davidenko, MD

  • Family Medicine Physician
  • Austintown, OH
  • NPI 1366739039
  Medicare reassignment
• Supreet Kaur Dhaliwal, M.D.

  • Family Medicine Physician
  • Austintown, OH
  • NPI 1396974796
  Medicare reassignment
• Sanjay Kadandale Shetty, MD

  • Diagnostic Radiology Physician
  • Boston, MA
  • NPI 1497738009
  NPD (past)

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

{
    "created_epoch": "1491782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491955200000",
    "number": "1114450764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 OHLTOWN RD",
            "city": "AUSTINTOWN",
            "state": "OH",
            "postal_code": "445152331",
            "telephone_number": "330-884-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 OHLTOWN RD",
            "city": "AUSTINTOWN",
            "state": "OH",
            "postal_code": "445152331",
            "telephone_number": "330-884-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHC YOUNGSTOWN OHIO OUTPATIENT SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-10",
        "last_updated": "2017-04-12",
        "status": "A",
        "authorized_official_last_name": "RICH",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OFFICER / DIRECTOR",
        "authorized_official_telephone_number": "330-884-1500"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Urgent Care Austintown",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Second Phase, Inc.
• David Sexton
• Cary Lynn Shaffer
• Payton Ashley Shannon, COUNSELOR IN TRAINEE
• Deena Lynn Shaw
• Mark Shehane, PEER SUPPORTER
• Morgan Shelton
• Shepherd of the Valley Lutheran Retirement Services, Inc.
• Charity Sherman
• Philip M Sherock, RN

• Urgent Care Clinic/Center in Austintown, OH
• Providers in Austintown, OH by specialty
• Urgent Care Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2017; 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.