Marymount Primary Care Services, Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

MARYMOUNT PRIMARY CARE SERVICES, INC

Practice address

4400 Rockside Rd
Suite 2100
Independence, OH 44131-2109

Phone

(216) 573-1300

Fax

(216) 503-5005

NPI assigned

Apr 20, 2007

Last updated

May 27, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Peter P Walchanowicz

Title

Practice Manager

Phone

(440) 543-8855

Specialties & licenses 2

Addresses

Other identifiers 2

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211846400000",
    "number": "1326265000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 ROCKSIDE RD",
            "address_2": "SUITE 2100",
            "city": "INDEPENDENCE",
            "state": "OH",
            "postal_code": "441312109",
            "telephone_number": "216-573-1300",
            "fax_number": "216-503-5005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 ROCKSIDE RD",
            "address_2": "SUITE 2100",
            "city": "INDEPENDENCE",
            "state": "OH",
            "postal_code": "441312109",
            "telephone_number": "216-573-1300",
            "fax_number": "216-503-5005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYMOUNT PRIMARY CARE SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2008-05-27",
        "status": "A",
        "authorized_official_last_name": "WALCHANOWICZ",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "440-543-8855",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000564073",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2698559",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary J Martin, OTR/L
• Shaliyah Martin
• Shawn Martin, PHARMD
• Marymount Behavioral Health Services
• Marymount Hospital, Inc.
• Marymount Primary Care Services, Inc.
• Tatiana Masyk, MD
• Kudzai Matemachani, SWT
• Christopher Daniel Matthews, LSW
• Dana Y Matthews, PHD., LPCC-S, NCC

• Internal Medicine Physician in Independence, OH
• Providers in Independence, OH by specialty
• Internal Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2008; 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.