NPIMap

Organization Active NPI

Outreach Professional Services Inc

Doing business as Cuyahoga Physician Network

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Westlake, OH
National Provider Identifier
1316129075
Registry record updated Jan 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
Legal business name
OUTREACH PROFESSIONAL SERVICES INC
Doing business as
Cuyahoga Physician Network
Practice address
29099 Health Campus Dr
Suite 380
Westlake, OH 44145
Phone
(440) 827-5390
Fax
(440) 827-5344
NPI assigned
Dec 4, 2007
Last updated
Jan 12, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2010

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

Authorized official

Name
Misty A Blaylock
Title
Credentialing Coordinator
Phone
(440) 892-6406

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X Primary

Addresses

Primary practice location

29099 Health Campus Dr
Suite 380
Westlake, OH 44145

Mailing address

26908 Detroit Rd
Suite 301
Westlake, OH 44145-2398
Phone (440) 617-1823

Other identifiers 1

IdentifierTypeStateIssuer
0251856MedicaidOH

Other names 1

  • Cuyahoga Physician Network Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Cuyahoga Physician Network22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1196726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263254400000",
    "number": "1316129075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26908 DETROIT RD",
            "address_2": "SUITE 301",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "441452398",
            "telephone_number": "440-617-1823",
            "fax_number": "440-617-0884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29099 HEALTH CAMPUS DR",
            "address_2": "SUITE 380",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "44145",
            "telephone_number": "440-827-5390",
            "fax_number": "440-827-5344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTREACH PROFESSIONAL SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-04",
        "last_updated": "2010-01-12",
        "status": "A",
        "authorized_official_last_name": "BLAYLOCK",
        "authorized_official_first_name": "MISTY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "440-892-6406"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0251856",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cuyahoga Physician Network",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Westlake, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 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.