NPIMap

Organization Active NPI

Kaiser Foundation Health Plan

Doing business as Willoughby Medical Offices

  • Clinic/Center
  • Willoughby, OH
National Provider Identifier
1174681183
Registry record updated Jul 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
KAISER FOUNDATION HEALTH PLAN
Doing business as
Willoughby Medical Offices
Practice address
5105 Som Center Road
Willoughby, OH 44094
Phone
(216) 265-8844
Fax
(216) 265-8890
NPI assigned
Dec 4, 2006
Last updated
Jul 19, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2012

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

Authorized official

Name
Craig Faerber
Title
VP Cfo
Phone
(216) 265-8844

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

5105 Som Center Road
Willoughby, OH 44094

Mailing address

12301 Snow Road
Parma, OH 44130
Phone (216) 265-8844

Other identifiers 1

IdentifierTypeStateIssuer
0211372MedicaidOH

Other names 1

  • Willoughby Medical Offices Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Healthspan Integrated Care23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342656000000",
    "number": "1174681183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12301 SNOW ROAD",
            "city": "PARMA",
            "state": "OH",
            "postal_code": "44130",
            "telephone_number": "216-265-8844",
            "fax_number": "216-265-8890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5105 SOM CENTER ROAD",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "44094",
            "telephone_number": "216-265-8844",
            "fax_number": "216-265-8890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HEALTH PLAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2012-07-19",
        "status": "A",
        "authorized_official_last_name": "FAERBER",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "VP CFO",
        "authorized_official_telephone_number": "216-265-8844"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0211372",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willoughby Medical Offices",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Willoughby, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2012; 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.