NPIMap

Organization Active NPI

Lorain County Health & Dentistry

  • Clinic/Center
  • Elyria, OH
National Provider Identifier
1336484559
Registry record updated Jun 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
LORAIN COUNTY HEALTH & DENTISTRY
Practice address
801 Middle Ave.
Elyria, OH 44035-5850
Phone
(440) 240-1655
Fax
(440) 240-1663
NPI assigned
Nov 28, 2012
Last updated
Jun 24, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2021

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

Authorized official

Name
Wanda Washington
Title
Credentialing Specialist
Phone
(440) 240-1655

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

801 Middle Ave.
Elyria, OH 44035-5850

Mailing address

1205 Broadway Ave
Lorain, OH 44052-3409
Phone (440) 240-1655

Other practice location 1

412 E. River St.
Elyria, OH 44035-5252
Phone (440) 240-1655

Other identifiers 1

IdentifierTypeStateIssuer
0441628MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031105000774 OH Part B Supplier - Clinic/Group Practice 9234047853 Receives reassigned benefits from 87 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Oberlin, OH; North Ridgeville, OH; Lorain, OH; Elyria, OH

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Lorain County Health Denti26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

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

View all 25

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1354060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624492800000",
    "number": "1336484559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 BROADWAY AVE",
            "city": "LORAIN",
            "state": "OH",
            "postal_code": "440523409",
            "telephone_number": "440-240-1655",
            "fax_number": "440-240-1663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 MIDDLE AVE.",
            "city": "ELYRIA",
            "state": "OH",
            "postal_code": "440355850",
            "telephone_number": "440-240-1655",
            "fax_number": "440-240-1663"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "412 E. River St.",
            "address_purpose": "LOCATION",
            "city": "Elyria",
            "state": "OH",
            "postal_code": "440355252",
            "country_code": "US",
            "telephone_number": "440-240-1655",
            "fax_number": "440-240-1663",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LORAIN COUNTY HEALTH & DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-28",
        "last_updated": "2021-06-24",
        "certification_date": "2021-06-24",
        "status": "A",
        "authorized_official_last_name": "WASHINGTON",
        "authorized_official_first_name": "WANDA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "440-240-1655"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0441628",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elyria, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.