NPIMap

Organization Active NPI

Signature Health Inc.

  • Federally Qualified Health Center (FQHC)
  • Ashtabula, OH
National Provider Identifier
1336687482
Registry record updated Feb 9, 2017
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
4726 Main Ave
Ashtabula, OH 44004-6929
Phone
(440) 992-6600
NPI assigned
Feb 9, 2017
Last updated
Feb 9, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2017

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

Authorized official

Name
Ryan Wood
Title
Cfo
Phone
(440) 953-9999

Specialties & licenses 1

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

Addresses

Primary practice location

4726 Main Ave
Ashtabula, OH 44004-6929

Mailing address

4726 Main Ave
Ashtabula, OH 44004-6929

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170426001841 OH Part A Provider - Federally Qualified Health Center (FQHC) 8628970985 Practice locations: Ashtabula, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336687482. Details of each certification follow.

Federally qualified health center certification: CCN 361131

Legal name
SIGNATURE HEALTH, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 20, 2017
Last certification
Apr 20, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 12, 1993 in OH
Enrollment address
4726 Main Ave
Ashtabula, OH 44004-6929

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

Locations

4726 Main Ave
Ashtabula, OH 44004
Phone (440) 992-8552

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 13, 1993
Corporate DirectorCeo Oct 13, 1993
W-2 Managing EmployeeCeo Oct 13, 1993
Paul Fuller Individual Corporate Director Jul 1, 2016
Heather Brissett Individual Corporate Director Jan 1, 2017
Kelly Farrell Individual Corporate Director Jul 1, 2016
Giovanni Dilalla Individual Corporate Director Jan 1, 2017
Jennifer Sample Individual Corporate Director Apr 1, 2017
Michelle Ann Echevarria Individual Corporate Director May 1, 2022
Paula Anzlovar Individual Corporate Director Apr 1, 2017
Georgia Brickman Individual Corporate Director Jul 1, 2016
Gregory Walker Individual Corporate Director May 1, 2022
Charles Strawbridge Individual Corporate Director Jul 1, 2016
Stephanie Malbasa Individual Corporate Director Jul 1, 2016
Josephine Jones Individual Corporate Director Jul 1, 2016
Earl Tucker Individual Corporate Director Feb 2, 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": "1486598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486598400000",
    "number": "1336687482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4726 MAIN AVE",
            "city": "ASHTABULA",
            "state": "OH",
            "postal_code": "440046929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4726 MAIN AVE",
            "city": "ASHTABULA",
            "state": "OH",
            "postal_code": "440046929",
            "telephone_number": "440-992-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIGNATURE HEALTH INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-09",
        "last_updated": "2017-02-09",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "440-953-9999"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ashtabula, OH

Sources for this page

Verify at the official NPI Registry.