Organization Active NPI

North Eastern Ohio Podiatry Group LLC

  • Foot & Ankle Surgery Podiatrist
  • Euclid, OH
National Provider Identifier
1295079085
Registry record updated Jul 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
NORTH EASTERN OHIO PODIATRY GROUP LLC
Practice address
99 Northline Circle
Suite #200
Euclid, OH 44119-1481
Phone
(440) 953-3668
NPI assigned
Nov 16, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2023

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

Authorized official

Name
Dr. Vadim Glukh, DPM
Title
Physician/Partner/Owner
Phone
(440) 953-3668

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X Primary

Addresses

Primary practice location

99 Northline Circle
Suite #200
Euclid, OH 44119-1481

Mailing address

35010 Chardon Rd
Suite #101a
Willoughby Hills, OH 44094-9010
Phone (440) 953-3668

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121227000136 OH DME Supplier - Physician - Podiatry 3072771336 Practice locations: Euclid, OH

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
North Eastern Ohio Podiatry3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1353024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689811200000",
    "number": "1295079085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35010 CHARDON RD",
            "address_2": "SUITE #101A",
            "city": "WILLOUGHBY HILLS",
            "state": "OH",
            "postal_code": "440949010",
            "telephone_number": "440-953-3668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 NORTHLINE CIRCLE",
            "address_2": "SUITE #200",
            "city": "EUCLID",
            "state": "OH",
            "postal_code": "441191481",
            "telephone_number": "440-953-3668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH EASTERN OHIO PODIATRY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-16",
        "last_updated": "2023-07-20",
        "certification_date": "2023-07-20",
        "status": "A",
        "authorized_official_last_name": "GLUKH",
        "authorized_official_first_name": "VADIM",
        "authorized_official_title_or_position": "PHYSICIAN/PARTNER/OWNER",
        "authorized_official_telephone_number": "440-953-3668",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Euclid, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2023; 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.