NPIMap

Individual provider Active NPI

Martin Epps Suber Sr., CDCA

  • Addiction (Substance Use Disorder) Counselor
  • Mansfield, OH
National Provider Identifier
1114565827
Registry record updated Dec 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
CDCA.170759 Issued in OH
Practice address
680 Park Ave W
Mansfield, OH 44906-3706
Phone
(419) 528-5993
Fax
(567) 560-5483
NPI assigned
Dec 12, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X CDCA.170759 OH Primary

Addresses

Primary practice location

680 Park Ave W
Mansfield, OH 44906-3706

Mailing address

680 Park Ave W
Mansfield, OH 44906-3706
Phone (419) 528-5993

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

LicenseStateTypeSpecialty
CDCA.170759OHMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Scioto Paint Valley Mental Health Center Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/spvmhc/r4/

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1576108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576108800000",
    "number": "1114565827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 PARK AVE W",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449063706",
            "telephone_number": "419-528-5993",
            "fax_number": "567-560-5483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 PARK AVE W",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449063706",
            "telephone_number": "419-528-5993",
            "fax_number": "567-560-5483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUBER",
        "first_name": "MARTIN",
        "middle_name": "EPPS",
        "name_suffix": "Sr.",
        "credential": "CDCA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-12-12",
        "last_updated": "2019-12-12",
        "certification_date": "2019-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "CDCA.170759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mansfield, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.