NPIMap

Organization Active NPI

Western Reserve Profess

Doing business as Western Reserve Spine & Pain Institute

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Kent, OH
National Provider Identifier
1356308407
Registry record updated Oct 24, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
Legal business name
WESTERN RESERVE PROFESS
Doing business as
Western Reserve Spine & Pain Institute
Practice address
307 W Main St
Kent, OH 44240-2400
Phone
(330) 677-3628
Fax
(330) 677-3626
NPI assigned
May 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2007

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

Authorized official

Name
Kelly Ann Semancik
Title
Administrative Director
Phone
(330) 677-3628

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NX0800X
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X Primary

Addresses

Primary practice location

307 W Main St
Kent, OH 44240-2400

Mailing address

PO Box 951971
Cleveland, OH 44193-0021
Phone (330) 548-0080

Other identifiers 4

IdentifierTypeStateIssuer
2311331MedicaidOH
2374434MedicaidOH
0251070MedicaidOH
2082866MedicaidOH

Other names 1

  • WESTERN RESERVE SPINE & PAIN INSTITUTE Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Western Reserve Professional Group5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

307 W Main St
Kent, OH 44240
Phone (330) 673-7538

NPI Registry JSON

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

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193184000000",
    "number": "1356308407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 951971",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441930021",
            "telephone_number": "330-548-0080",
            "fax_number": "330-548-0084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 W MAIN ST",
            "city": "KENT",
            "state": "OH",
            "postal_code": "442402400",
            "telephone_number": "330-677-3628",
            "fax_number": "330-677-3626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN RESERVE PROFESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-01",
        "last_updated": "2007-10-24",
        "status": "A",
        "authorized_official_last_name": "SEMANCIK",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "330-677-3628"
    },
    "taxonomies": [
        {
            "code": "111NX0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2311331",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2374434",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0251070",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2082866",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WESTERN RESERVE SPINE & PAIN INSTITUTE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kent, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2007; 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.