Active NPI
Stephanie Conwell, M.D.
- Emergency Medicine Physician
- Cleveland, OH
National Provider Identifier
1205876505
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 35057279
- Practice address
- 18101 Lorain Ave
Cleveland, OH 44111-5612 - Phone
- (216) 476-7213
- NPI assigned
- Jun 7, 2006
- Last updated
- Jul 7, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 35057279 | OH | Primary |
Addresses
Primary practice location
18101 Lorain Ave
Cleveland, OH 44111-5612
Mailing address
21091 W Wagar Cir
Rocky River, OH 44116-2320
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 930008866 | Other | OH | MEDICARE TRAVELERS RR-GA |
| 942460636278 | Other | OH | CARESOURCE |
| 0747393 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35057279 | OH | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Primary Care Practices Inc. | Past | Accepting new patients | |
| Oscar Nicholson Jr MD Inc | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404691200000",
"number": "1205876505",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21091 W WAGAR CIR",
"city": "ROCKY RIVER",
"state": "OH",
"postal_code": "441162320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18101 LORAIN AVE",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441115612",
"telephone_number": "216-476-7213"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONWELL",
"first_name": "STEPHANIE",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-06-07",
"last_updated": "2014-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "OH",
"license": "35057279",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE TRAVELERS RR-GA",
"identifier": "930008866",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARESOURCE",
"identifier": "942460636278",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0747393",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.