NPIMap

Organization Active NPI

Signature Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Willoughby, OH
National Provider Identifier
1306612882
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SIGNATURE HEALTH, INC.
Practice address
38876 Mentor Avenue
Willoughby, OH 44094
Phone
(440) 953-9999
Fax
(440) 918-3839
NPI assigned
Nov 27, 2023
Last updated
Nov 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Authorized official

Name
Jonathan Albert Lee
Title
Ceo
Phone
(440) 578-8200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

38876 Mentor Avenue
Willoughby, OH 44094

Mailing address

7232 Justin Way
Mentor, OH 44060-4881
Phone (440) 578-8200

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231214000159 OH Part A Provider - Federally Qualified Health Center (FQHC) 8628970985 Practice locations: Willoughby, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306612882. Details of each certification follow.

Federally qualified health center certification: CCN D21025

Legal name
SIGNATURE HEALTH, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 13, 2023
Last certification
Dec 13, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 12, 1993 in OH
Enrollment address
38876 Mentor Ave.
Willoughby, OH 44094-7931

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
The North Coast Center29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

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

View all 28

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jonathan Lee Individual Corporate OfficerCeo Oct 12, 1993
W-2 Managing EmployeeCeo Oct 12, 1993
Operational/Managerial ControlCeo Oct 13, 1993
Paul Fuller Individual Corporate DirectorBoard Member Jan 1, 2017
Heather Brissett Individual Corporate DirectorBoard Member Jan 1, 2017
Kelly Farrell Individual Corporate DirectorBoard Member Jan 1, 2017
Giovanni Dilalla Individual Corporate DirectorBoard Member Jan 1, 2017
Jennifer Sample Individual Corporate DirectorBoard Member Apr 1, 2017
Michelle Ann Echevarria Individual Corporate DirectorBoard Member May 1, 2022
Paula Anzlovar Individual Corporate DirectorBoard Chair Apr 1, 2017
Georgia Brickman Individual Corporate DirectorBoard Member Sep 15, 1979
Gregory Walker Individual Corporate DirectorBoard Member May 1, 2022
Charles Strawbridge Individual Corporate DirectorBoard Member Jul 1, 2016
Stephanie Malbasa Individual Corporate DirectorBoard Member Jan 1, 2016
Josephine Jones Individual Corporate DirectorBoard Member Jan 1, 2017
Earl Tucker Individual Corporate DirectorBoard Member Feb 1, 2021

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1701043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1306612882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7232 JUSTIN WAY",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440604881",
            "telephone_number": "440-578-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38876 MENTOR AVENUE",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "44094",
            "telephone_number": "440-953-9999",
            "fax_number": "440-918-3839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIGNATURE HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-27",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "ALBERT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "440-578-8200"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willoughby, OH

Sources for this page

Verify at the official NPI Registry.