NPIMap

Organization Active NPI

Clinic Physician Services Co. LLC

  • Anesthesiology Physician
  • Mayfield HTS, OH
National Provider Identifier
1235127408
Registry record updated Feb 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
CLINIC PHYSICIAN SERVICES CO. LLC
Practice address
6780 Mayfield Rd
Mayfield HTS, OH 44124-2203
Phone
(440) 312-4500
NPI assigned
Oct 11, 2005
Last updated
Feb 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2022

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

Authorized official

Name
Mr. Tim Longville
Title
Chief Accounting Officer and Contro
Phone
(216) 636-7416

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X Primary
Interventional Pain Medicine Physician 208VP0014X

Addresses

Primary practice location

6780 Mayfield Rd
Mayfield HTS, OH 44124-2203

Mailing address

6801 Brecksville Rd
RK1-19
Independence, OH 44131-5032
Phone (216) 442-1840

Other identifiers 10

IdentifierTypeStateIssuer
2173615MedicaidOH
2175882MedicaidOH
2355099MedicaidOH
2173651MedicaidOH
2545811MedicaidOH
2178272MedicaidOH
2173660MedicaidOH
2178290MedicaidOH
2475165MedicaidOH
CG8024OtherOHRAILROAD MEDICARE

National Provider Directory

National Provider Directory

Locations

6801 Brecksville Rd
#119
Independence, OH 44131

Practitioners & affiliated clinicians

Practitioners 271

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.

View all 271

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645574400000",
    "number": "1235127408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6801 BRECKSVILLE RD",
            "address_2": "RK1-19",
            "city": "INDEPENDENCE",
            "state": "OH",
            "postal_code": "441315032",
            "telephone_number": "216-442-1840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6780 MAYFIELD RD",
            "city": "MAYFIELD HTS",
            "state": "OH",
            "postal_code": "441242203",
            "telephone_number": "440-312-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINIC PHYSICIAN SERVICES CO. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-11",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-23",
        "status": "A",
        "authorized_official_last_name": "LONGVILLE",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER AND CONTRO",
        "authorized_official_telephone_number": "216-636-7416",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2173615",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2175882",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2355099",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2173651",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2545811",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2178272",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2173660",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2178290",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2475165",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CG8024",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mayfield HTS, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2022; 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.