Active NPI
Mercurious Mina
- Periodontics
- Cleveland, OH
National Provider Identifier
1336767847
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- RES.004174
- Practice address
- 9601 Chester Ave
Cleveland, OH 44106-1666 - Phone
- (216) 368-3200
- NPI assigned
- Jul 10, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | RES.004174 | OH | Primary |
Addresses
Primary practice location
9601 Chester Ave
Cleveland, OH 44106-1666
Mailing address
35 Severance Cir
Cleveland Heights, OH 44118-1523
Phone (216) 797-0500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RES.004174 | OH | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594339200000",
"number": "1336767847",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "35 SEVERANCE CIR",
"city": "CLEVELAND HEIGHTS",
"state": "OH",
"postal_code": "441181523",
"telephone_number": "216-797-0500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9601 CHESTER AVE",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441061666",
"telephone_number": "216-368-3200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MINA",
"first_name": "MERCURIOUS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-07-10",
"last_updated": "2020-07-10",
"certification_date": "2020-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "OH",
"license": "RES.004174",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.