NPIMap

Organization Active NPI

Southwest General Medical Group, Inc.

  • Orthopaedic Surgery Physician
  • Brookpark, OH
National Provider Identifier
1144414871
Registry record updated Feb 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
SOUTHWEST GENERAL MEDICAL GROUP, INC.
Practice address
15900 Snow Rd
Brook Park, OH 44142-2859
Phone
(216) 676-1234
Fax
(440) 816-6438
NPI assigned
Sep 6, 2007
Last updated
Feb 28, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2019

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

Authorized official

Name
Heather Wagner
Title
Executive Director
Phone
(440) 816-4906

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X NU Primary

Addresses

Primary practice location

15900 Snow Rd
Brook Park, OH 44142-2859

Mailing address

PO Box 638269
Cincinnati, OH 45263-0001
Phone (440) 816-5390

Other identifiers 2

IdentifierTypeStateIssuer
2692466MedicaidOH
2238144MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031210000789 OH Part B Supplier - Clinic/Group Practice 8527964550 Receives reassigned benefits from 307 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Middleburg Heights, OH; Middleburg HTS, OH; North Olmsted, OH; North Royalton, OH; Olmsted TWP, OH; Parma, OH; Strongsville, OH; Westlake, OH…

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1189036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551312000000",
    "number": "1144414871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 638269",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452630001",
            "telephone_number": "440-816-5390",
            "fax_number": "440-816-6438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15900 SNOW RD",
            "city": "BROOK PARK",
            "state": "OH",
            "postal_code": "441422859",
            "telephone_number": "216-676-1234",
            "fax_number": "440-816-6438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST GENERAL MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-06",
        "last_updated": "2019-02-28",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "440-816-4906"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2692466",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2238144",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookpark, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2019; 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.