NPIMap

Organization Active NPI

Northeast Ohio Neighborhood Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Cleveland, OH
National Provider Identifier
1396093597
Registry record updated Aug 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.
Practice address
9127 Miles Ave
Cleveland, OH 44105-6136
Phone
(216) 231-7700
NPI assigned
Aug 17, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2012

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

Authorized official

Name
Willie F. Austin
Title
President and Ceo
Phone
(216) 231-7700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

9127 Miles Ave
Cleveland, OH 44105-6136

Mailing address

4800 Payne Ave
Cleveland, OH 44103-2443
Phone (216) 231-7700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130530000641 OH Part A Provider - Federally Qualified Health Center (FQHC) 5799756615 Practice locations: Cleveland, OH

Federally qualified health center certification: CCN 361028

Legal name
NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 23, 2013
Last certification
May 23, 2013
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Mar 24, 1967 in OH
Enrollment address
9127 Miles Ave
Cleveland, OH 44105-6136

Other NPIs with the same Medicare PAC ID 12

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Northeast Ohio Neighbor14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Tenisha Gant-Watson Individual Corporate DirectorBoard Member Jan 1, 2015
Liang Chen Individual Corporate OfficerChief Financial Officer Jan 1, 2019
Karen Butler Individual Corporate OfficerChief Operating Officer Apr 1, 2014
Willie F Austin Individual Corporate OfficerPresident and Ceo Mar 31, 2003
W-2 Managing EmployeePresident & Ceo Mar 31, 2003
Phyllis Weeden-Oliver Individual Corporate DirectorBoard Member Jan 1, 2012
Stacie Spears Individual Corporate DirectorBoard Member Jan 1, 2012
Anita M Watson Individual Corporate DirectorMedical Director Jan 1, 2013
Audra Ameen Individual Corporate DirectorBoard Member Jul 1, 2010
Edward McGhee Individual Corporate DirectorMember of the Board of Trustees Mar 10, 2021

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

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

{
    "created_epoch": "1345161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345161600000",
    "number": "1396093597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 PAYNE AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441032443",
            "telephone_number": "216-231-7700",
            "fax_number": "216-231-3828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9127 MILES AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441056136",
            "telephone_number": "216-231-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-17",
        "last_updated": "2012-08-17",
        "status": "A",
        "authorized_official_last_name": "AUSTIN",
        "authorized_official_first_name": "WILLIE",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "216-231-7700"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.