NPIMap

Organization Active NPI

Baymark Health Services of Ohio, Inc.

Doing business as MedMark Treatment Centers Youngstown

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Boardman, OH
National Provider Identifier
1366018228
Registry record updated Jul 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
BAYMARK HEALTH SERVICES OF OHIO, INC.
Doing business as
MedMark Treatment Centers Youngstown
Practice address
900 Sahara TRL
Boardman, OH 44514-3667
Phone
(330) 267-9020
Fax
(330) 267-9270
NPI assigned
Jun 1, 2021
Last updated
Jul 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2024

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

Authorized official

Name
Bruce Jarvie
Title
VP, Treasurer
Phone
(214) 379-3300

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

900 Sahara TRL
Boardman, OH 44514-3667

Mailing address

1720 Lakepointe Dr Ste 117
Lewisville, TX 75057-6425
Phone (214) 379-3300

Other names 1

  • MedMark Treatment Centers Youngstown Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Opioid treatment program
Medicare-enrolled since Oct 1, 2020

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201203002704 OH Part B Supplier - Opioid Treatment Program (Otp) 3870845761 9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Columbus, OH; Youngstown, OH; Milford, OH; Lebanon, OH; Kent, OH; Dayton, OH; Amherst, OH

Other NPIs on the same Medicare enrollment 9

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D2227456Baymark Health Services of Ohio, Inc900 Sahara Trail, Boardman, OH 44514Certificate of waiverJun 10, 2027

National Provider Directory

National Provider Directory
Tax ID family
Baymark Health Services of Ohio Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

NPI Registry JSON

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

{
    "created_epoch": "1622505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722211200000",
    "number": "1366018228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 LAKEPOINTE DR STE 117",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750576425",
            "telephone_number": "214-379-3300",
            "fax_number": "214-853-9018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 SAHARA TRL",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445143667",
            "telephone_number": "330-267-9020",
            "fax_number": "330-267-9270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYMARK HEALTH SERVICES OF OHIO, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-01",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A",
        "authorized_official_last_name": "JARVIE",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "VP, TREASURER",
        "authorized_official_telephone_number": "214-379-3300"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MedMark Treatment Centers Youngstown",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MedMark Treatment Centers Youngstown",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boardman, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.