Active NPI
Elisabeth Anna Banasik
- Dentist
- Cleveland, OH
National Provider Identifier
1386164655
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 30024966
- Practice address
- Case Western Reserve School of Dental Medicine
2124 Cornell Road
Cleveland, OH 44106 - Phone
- (216) 368-8665
- NPI assigned
- Jun 27, 2017
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 30024966 | OH | Primary |
Addresses
Primary practice location
Case Western Reserve School of Dental Medicine
2124 Cornell Road
Cleveland, OH 44106
Mailing address
10 Eleven River
Rocky River, OH 44116
Phone (216) 280-6949
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 |
|---|---|---|---|
| 30024966 | OH | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1498521600000",
"number": "1386164655",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 ELEVEN RIVER",
"city": "ROCKY RIVER",
"state": "OH",
"postal_code": "44116",
"telephone_number": "216-280-6949"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "CASE WESTERN RESERVE SCHOOL OF DENTAL MEDICINE",
"address_2": "2124 CORNELL ROAD",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "44106",
"telephone_number": "216-368-8665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANASIK",
"first_name": "ELISABETH",
"middle_name": "ANNA",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-06-27",
"last_updated": "2017-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist",
"state": "OH",
"license": "30024966",
"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 Jun 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.