NPIMap

Individual provider Active NPI

John J Baniewicz, MD

  • Internal Medicine Physician
  • Mentor, OH
National Provider Identifier
1285740530
Registry record updated Mar 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35-058500 Issued in OH
Practice address
9485 Mentor Ave
Ste 210
Mentor, OH 44060
Phone
(440) 205-5835
Fax
(440) 205-5735
NPI assigned
Aug 21, 2006
Last updated
Mar 1, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35-058500 OH Primary

Addresses

Primary practice location

9485 Mentor Ave
Ste 210
Mentor, OH 44060

Mailing address

36000 Euclid Ave
Mso
Willoughby, OH 44094
Phone (440) 953-6082

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address john.baniewicz@lhpg.eclinicaldirectplus.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040108000322 OH Practitioner - Internal Medicine 0143129114 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Northeastern Ohio University College of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lake Hospital System, Inc.Group PAC ID 6002713922, 92 clinicians

Practice addresses (Care Compare)

9485 Mentor Ave
Suite 210
Mentor, OH 44060-8723
Phone (440) 205-5835

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35-058500OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Hospital System, Inc Internal Medicine CurrentSince May 23, 2007 Accepting new patients
Lake Hospital System, Inc Internal Medicine CurrentSince May 23, 2007 Accepting new patients
Lake Hospital System Inc Internal Medicine Current Accepting new patients

Locations

9485 Mentor Ave
Ste 210
Mentor, OH 44060
Phone (440) 255-5571

10780 Kinsman Rd
Newbury, OH 44065
Phone (440) 564-5656

36100 Euclid Ave
Ste 240
Willoughby, OH 44094
Phone (216) 953-6294

36000 Euclid Ave
Willoughby Hills, OH 44094
Phone (440) 375-8166

Interoperability endpoints

  • Direct secure messaging: jbaniewicz87090@ehrdirect.uhhospitals.org
  • Direct secure messaging: john.baniewicz@lhpg.eclinicaldirectplus.com

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lake HealthWilloughby, OH, CCN 360098 Hospital Corporate Officer
W-2 Managing Employee		 Dec 4, 2014
Dec 4, 2014
Lake Health Center for Geriatric PsychiatryConcord TWP, OH, CCN 36S098 Hospital Corporate Officer
W-2 Managing Employee		 Dec 4, 2014
Dec 4, 2014
Lake HealthConcord TWP, OH, CCN 36T098 Hospital Corporate Officer
W-2 Managing Employee		 Dec 4, 2014
Dec 4, 2014
Lake Health Beachwood Medical CenterBeachwood, OH, CCN 360367 Hospital Corporate Director Dec 12, 2018

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614556800000",
    "number": "1285740530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36000 EUCLID AVE",
            "address_2": "MSO",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "44094",
            "telephone_number": "440-953-6082",
            "fax_number": "440-953-6101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9485 MENTOR AVE",
            "address_2": "STE 210",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "44060",
            "telephone_number": "440-205-5835",
            "fax_number": "440-205-5735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANIEWICZ",
        "first_name": "JOHN",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-21",
        "last_updated": "2021-03-01",
        "certification_date": "2021-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35-058500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "john.baniewicz@lhpg.eclinicaldirectplus.com",
            "affiliation": "N",
            "endpointDescription": "Baseline West Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "9485 Mentor Ave",
            "address_2": "Ste 210",
            "city": "Mentor",
            "state": "OH",
            "country_code": "US",
            "postal_code": "44060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mentor, OH

Sources for this page

Verify at the official NPI Registry.