NPIMap

Organization Active NPI

Executive Court Medical Associates Inc.

  • Family Medicine Physician
  • Norwalk, OH
National Provider Identifier
1184794885
Registry record updated Oct 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
EXECUTIVE COURT MEDICAL ASSOCIATES INC.
Practice address
54 Executive Dr
Norwalk, OH 44857-9566
Phone
(419) 668-5607
Fax
(419) 668-9706
NPI assigned
Nov 9, 2006
Last updated
Oct 17, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2007

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

Authorized official

Name
Mr. Graham M Johnson, CMOM
Title
Business Manager
Phone
(419) 668-5607

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

54 Executive Dr
Norwalk, OH 44857-9566

Mailing address

54 Executive Dr
Norwalk, OH 44857-9566
Phone (419) 668-5607

Other identifiers 1

IdentifierTypeStateIssuer
842075MedicaidOH

National Provider Directory

National Provider Directory

Locations

54 Executive Dr
Ste A
Norwalk, OH 44857
Phone (419) 668-5607

997 Highway 17 S
Surfside Beach, SC 29575

Practitioners & affiliated clinicians

Practitioners 10

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": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192579200000",
    "number": "1184794885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 EXECUTIVE DR",
            "city": "NORWALK",
            "state": "OH",
            "postal_code": "448579566",
            "telephone_number": "419-668-5607",
            "fax_number": "419-668-9706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 EXECUTIVE DR",
            "city": "NORWALK",
            "state": "OH",
            "postal_code": "448579566",
            "telephone_number": "419-668-5607",
            "fax_number": "419-668-9706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE COURT MEDICAL ASSOCIATES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2007-10-17",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "GRAHAM",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "419-668-5607",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CMOM"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "842075",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norwalk, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; 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.