Individual provider Active NPI

Rachel Koprivnak, SLP

  • Speech-Language Pathologist
  • Painesville, OH
National Provider Identifier
1184740532
Registry record updated May 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SP8607 Issued in OH
Practice address
6295 Conley Rd
Painesville, OH 44077-8860
Phone
(330) 322-6062
NPI assigned
Mar 21, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SP08607 OH
Speech-Language Pathologist 235Z00000X SP8607 OH Primary

Addresses

Primary practice location

6295 Conley Rd
Painesville, OH 44077-8860

Mailing address

6295 Conley Rd
Painesville, OH 44077-8860
Phone (330) 322-6062

Other practice location 1

3 Merit Dr
Richmond Heights, OH 44143-1457
Phone (216) 261-9600

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241213000856 OH Practitioner - Qualified Speech Language Pathologist 3577099522 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Healthcare Services IncGroup PAC ID 2163339722, 3,431 clinicians

Practice addresses (Care Compare)

3720 N Ridge Rd W
Ashtabula, OH 44004-6366
Phone (440) 261-3106

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SP08607OHMDSpeech-Language Pathologist
SP8607OHMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Healthcare Services Inc Speech-Language Pathologist CurrentSince Nov 11, 2024 Accepting new patients
Legacy Healthcare Services Inc Speech-Language Pathologist CurrentSince Nov 11, 2024 Accepting new patients

Locations

110 Horizon Dr
#310
Raleigh, NC 27615

3720 N Ridge Rd W
Ashtabula, OH 44004
Phone (440) 261-3100

Organizations & group practices 2

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": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557100800000",
    "number": "1184740532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6295 CONLEY RD",
            "city": "PAINESVILLE",
            "state": "OH",
            "postal_code": "440778860",
            "telephone_number": "330-322-6062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6295 CONLEY RD",
            "city": "PAINESVILLE",
            "state": "OH",
            "postal_code": "440778860",
            "telephone_number": "330-322-6062"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3 Merit Dr",
            "address_purpose": "LOCATION",
            "city": "Richmond Heights",
            "state": "OH",
            "postal_code": "441431457",
            "country_code": "US",
            "telephone_number": "216-261-9600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOPRIVNAK",
        "first_name": "RACHEL",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-21",
        "last_updated": "2019-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OH",
            "license": "SP08607",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OH",
            "license": "SP8607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Painesville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.