Jeremiah Berdiel, PEER SUPPORTER

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

0002620 Issued in OH

Practice address

14445 Broadway Ave
Cleveland, OH 44125-1957

Phone

(216) 677-8177

NPI assigned

Jun 20, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Legend Treatment Center of Cleveland, LLC

  • Community/Behavioral Health Agency
  • Cleveland, OH
  • NPI 1477342962
  NPD
• McIntyre Center Inc.

  • Community/Behavioral Health Agency
  • Parma, OH
  • NPI 1023453867
  NPD (past)

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

{
    "created_epoch": "1655683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702339200000",
    "number": "1366173544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14445 BROADWAY AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441251957",
            "telephone_number": "216-677-8177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14445 BROADWAY AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441251957",
            "telephone_number": "216-677-8177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERDIEL",
        "first_name": "JEREMIAH",
        "credential": "PEER SUPPORTER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-20",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "OH",
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OH",
            "license": "0002620",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHMAS",
            "identifier": "0002620",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edward C Benzel, MD
• Kaustav Bera, MBBS
• Raychel Berardinelli
• Nadia Beraun Fuchs, QMHS BA CMS BA
• Eren Berber, MD
• Berea Childrens Home and Family Services
• Megan Bereda, PHARMD
• Yelena Beregovskaya, C.N.M.
• Janil Berendsen
• Kayleigh Berendt, PRS

• Peer Specialist in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Peer Specialist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; 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.