NPIMap

Organization Active NPI

Signature Health, Inc

  • Federally Qualified Health Center (FQHC)
  • Cleveland, OH
National Provider Identifier
1184110769
Registry record updated Jul 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SIGNATURE HEALTH, INC
Practice address
1400 W 25TH St FL 2
Cleveland, OH 44113-3151
Phone
(168) 316-4662
Fax
(440) 918-3839
NPI assigned
Jul 6, 2018
Last updated
Jul 6, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2018

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

Authorized official

Name
Jonathan Albert Lee
Title
Ceo
Phone
(440) 953-9999

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1400 W 25TH St FL 2
Cleveland, OH 44113-3151

Mailing address

38882 Mentor Ave
Willoughby, OH 44094-7875
Phone (440) 953-9999

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180829001605 OH Part A Provider - Federally Qualified Health Center (FQHC) 8628970985 Practice locations: Lakewood, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184110769. Details of each certification follow.

Federally qualified health center certification: CCN 361181

Legal name
SIGNATURE HEALTH, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 24, 2018
Last certification
Aug 24, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 12, 1993 in OH
Enrollment address
14701 Detroit Ave
FL 6
Lakewood, OH 44107-4115

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
The North Coast Center29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

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

View all 28

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jonathan Lee Individual Corporate OfficerCeo Oct 12, 1993
W-2 Managing EmployeeCeo Oct 12, 1993
Paul Fuller Individual Corporate DirectorDirector Jan 1, 2017
Heather Brissett Individual Corporate Director Jan 1, 2017
Kelly Farrell Individual Corporate DirectorDirector Jan 1, 2017
Giovanni Dilalla Individual Corporate Director Jan 1, 2017
Jennifer Sample Individual Corporate Director Apr 1, 2017
Paula Anzlovar Individual Corporate Director Apr 1, 2017
Georgia Brickman Individual Corporate DirectorDirector Jan 1, 2017
Gregory Walker Individual Corporate Director May 1, 2022
Charles Strawbridge Individual Corporate Director Jul 1, 2016
Stephanie Malbasa Individual Corporate Director Jan 1, 2016
Josephine Jones Individual Corporate Director Jan 1, 2017
Earl Tucker Individual Corporate Director Feb 2, 2021

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 1

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": "1530835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530835200000",
    "number": "1184110769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38882 MENTOR AVE",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440947875",
            "telephone_number": "440-953-9999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 W 25TH ST FL 2",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441133151",
            "telephone_number": "168-316-4662",
            "fax_number": "440-918-3839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIGNATURE HEALTH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-06",
        "last_updated": "2018-07-06",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "ALBERT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "440-953-9999"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.