Active NPI
Paul Theodore Omelsky, M.D.
- Child & Adolescent Psychiatry Physician
- Cleveland HTS, OH
National Provider Identifier
1346304607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- 35.031025
- Practice address
- 2460 Fairmount Blvd
Siute 212
Cleveland HTS, OH 44106-3171 - Phone
- (216) 536-8479
- Fax
- (216) 932-7668
- NPI assigned
- Dec 21, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | 35.031025 | OH | Primary |
Addresses
Primary practice location
2460 Fairmount Blvd
Siute 212
Cleveland HTS, OH 44106-3171
Mailing address
2460 Fairmount Blvd
Suite 212
Cleveland HTS, OH 44106-3171
Phone (216) 536-8479
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0150223 | Medicaid | OH |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35.031025 | OH | MD | Child & Adolescent Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of Ohio Department of Mental Health | Past | Accepting new patients | |
| State of Ohio Office of Budget and Management State Accounting | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Case Management Agency
- Medina, OH
- NPI 1407825474
-
- Nursing Facility/Intermediate Care Facility
- Sandusky, OH
- NPI 1790732576
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257984000000",
"number": "1346304607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2460 FAIRMOUNT BLVD",
"address_2": "SUITE 212",
"city": "CLEVELAND HTS",
"state": "OH",
"postal_code": "441063171",
"telephone_number": "216-536-8479",
"fax_number": "216-932-7668"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2460 FAIRMOUNT BLVD",
"address_2": "SIUTE 212",
"city": "CLEVELAND HTS",
"state": "OH",
"postal_code": "441063171",
"telephone_number": "216-536-8479",
"fax_number": "216-932-7668"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OMELSKY",
"first_name": "PAUL",
"middle_name": "THEODORE",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-21",
"last_updated": "2009-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "OH",
"license": "35.031025",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0150223",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cleveland HTS, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.