Individual provider Active NPI

Summer Watterson, CNP

  • Nurse Practitioner
  • Parma, OH
National Provider Identifier
1386408318
Registry record updated Feb 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
035831 Issued in OH
Practice address
12380 Plaza Dr # 101
Parma, OH 44130-1043
Phone
(216) 898-8488
Fax
(216) 362-0677
NPI assigned
Feb 9, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 035831 OH Primary

Addresses

Primary practice location

12380 Plaza Dr # 101
Parma, OH 44130-1043

Mailing address

12380 Plaza Dr # 101
Parma, OH 44130-1043
Phone (216) 898-8488

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240305001179 OH Practitioner - Nurse Practitioner 9739524356 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Stafford Services, Inc.Group PAC ID 4486678901, 28 clinicians

Practice addresses (Care Compare)

12380 Plaza Dr
Parma, OH 44130-1043
Phone (216) 898-8488

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
035831OHMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Stafford Services, Inc. CurrentSince Feb 26, 2024 Accepting new patients

Locations

12380 Plaza Dr
Ste 101
Parma, OH 44130
Phone (216) 898-8444

12380 Plaza Dr
#101
Parma, OH 44130
Phone (216) 898-8488

12380 Plaza Dr
Parma, OH 44130
Phone (216) 898-8444

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1707436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707436800000",
    "number": "1386408318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12380 PLAZA DR # 101",
            "city": "PARMA",
            "state": "OH",
            "postal_code": "441301043",
            "telephone_number": "216-898-8488",
            "fax_number": "216-362-0677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12380 PLAZA DR # 101",
            "city": "PARMA",
            "state": "OH",
            "postal_code": "441301043",
            "telephone_number": "216-898-8488",
            "fax_number": "216-362-0677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATTERSON",
        "first_name": "SUMMER",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-09",
        "last_updated": "2024-02-09",
        "certification_date": "2023-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "035831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Parma, OH

Sources for this page

Verify at the official NPI Registry.