NPIMap

Organization Active NPI

Silver Lake Psychiatry, LLC

  • Psychiatry Physician
  • Stow, OH
National Provider Identifier
1295304723
Registry record updated Jun 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
SILVER LAKE PSYCHIATRY, LLC
Practice address
4466 Darrow Rd Ste 14
Stow, OH 44224-1891
Phone
(330) 858-1173
Fax
(330) 967-0151
NPI assigned
Jun 19, 2021
Last updated
Jun 19, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2021

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

Authorized official

Name
Dr. Marnie Alexandra Neill, MD
Title
Director of Clinical Services
Phone
(330) 858-1173

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X NU
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

4466 Darrow Rd Ste 14
Stow, OH 44224-1891

Mailing address

4466 Darrow Rd Ste 14
Stow, OH 44224-1891
Phone (330) 858-1173

Other identifiers 1

IdentifierTypeStateIssuer
0151055MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240510003027 OH Part B Supplier - Clinic/Group Practice 2860833605 Receives reassigned benefits from 1 practitioner
Practice locations: Stow, OH

National Provider Directory

National Provider Directory

Locations

4301 Darrow Rd
Ste 3500
Stow, OH 44224
Phone (234) 208-6299

4466 Darrow Rd
Ste 14
Stow, OH 44224
Phone (330) 858-1173

24500 Center Ridge Rd
Ste 277
Westlake, OH 44145

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1624060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624060800000",
    "number": "1295304723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4466 DARROW RD STE 14",
            "city": "STOW",
            "state": "OH",
            "postal_code": "442241891",
            "telephone_number": "330-858-1173",
            "fax_number": "330-967-0151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4466 DARROW RD STE 14",
            "city": "STOW",
            "state": "OH",
            "postal_code": "442241891",
            "telephone_number": "330-858-1173",
            "fax_number": "330-967-0151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SILVER LAKE PSYCHIATRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-19",
        "last_updated": "2021-06-19",
        "certification_date": "2021-06-19",
        "status": "A",
        "authorized_official_last_name": "NEILL",
        "authorized_official_first_name": "MARNIE",
        "authorized_official_middle_name": "ALEXANDRA",
        "authorized_official_title_or_position": "DIRECTOR OF CLINICAL SERVICES",
        "authorized_official_telephone_number": "330-858-1173",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0151055",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stow, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2021; 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.