Open Awareness Medical LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

OPEN AWARENESS MEDICAL LLC

Practice address

875 Blake Ave SW
Suite #2
New Philadelphia, OH 44663-9338

Phone

(330) 339-9000

Fax

(330) 339-1122

NPI assigned

Jan 4, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Randy W McClelland

Title

Office Manager

Phone

(330) 339-9000

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1262563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291161600000",
    "number": "1275863896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "875 BLAKE AVE SW",
            "address_2": "SUITE #2",
            "city": "NEW PHILADELPHIA",
            "state": "OH",
            "postal_code": "446639338",
            "telephone_number": "330-339-9000",
            "fax_number": "330-339-1122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 BLAKE AVE SW",
            "address_2": "SUITE #2",
            "city": "NEW PHILADELPHIA",
            "state": "OH",
            "postal_code": "446639338",
            "telephone_number": "330-339-9000",
            "fax_number": "330-339-1122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN AWARENESS MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-04",
        "last_updated": "2010-12-01",
        "status": "A",
        "authorized_official_last_name": "MCCLELLAND",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "330-339-9000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0340929",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2010; 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.