NPIMap

Organization Active NPI

Whitestar Professional Corporation

  • Ophthalmology Physician
  • Westlake, OH
National Provider Identifier
1215997804
Registry record updated Jun 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
WHITESTAR PROFESSIONAL CORPORATION
Practice address
2237 Crocker Rd
Suite 100
Westlake, OH 44145-6789
Phone
(440) 892-3931
NPI assigned
Mar 27, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Darrell WhiteNPI 1417918517
Title
Owner
Phone
(440) 892-3931

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Corporate family (same tax ID) 2

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

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Medicare enrollment records 2

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20041004000344 OH Part B Supplier - Clinic/Group Practice 8921067224 Receives reassigned benefits from 6 practitioners
Practice locations: Westlake, OH
O20140714001235 OH DME Supplier - Physician - Ophthalmology 8921067224 Practice locations: Westlake, OH

National Provider Directory

National Provider Directory
Tax ID family
Skyvision Centers (3 organizations share this tax ID)

Locations

10680 Lorain Ave
Cleveland, OH 44111
Phone (216) 671-2998

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

2237 Crocker Rd
Suite 100
Westlake, OH 44145-6789

Mailing address

2237 Crocker Rd
Suite 100
Westlake, OH 44145-6789

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
2534574MedicaidOH

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 25, 2008.

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1215997804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2237 CROCKER RD",
            "address_2": "SUITE 100",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "441456789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2237 CROCKER RD",
            "address_2": "SUITE 100",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "441456789",
            "telephone_number": "440-892-3931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITESTAR PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-27",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "DARRELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "440-892-3931"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2534574",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Westlake, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.