NPIMap

Organization Active NPI

Debalzo Elgudin Levine Risen LLC

  • Psychiatry Physician
  • Beachwood, OH
National Provider Identifier
1396286191
Registry record updated Mar 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
DEBALZO ELGUDIN LEVINE RISEN LLC
Practice address
23425 Commerce Park
Suite 104
Beachwood, OH 44122-5844
Phone
(216) 831-2900
Fax
(216) 831-4306
NPI assigned
Mar 13, 2017
Last updated
Mar 13, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2017

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

Authorized official

Name
Dr. Larissa Elgudin, MDNPI 1629004387
Title
Co-Director
Phone
(216) 831-2900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0804X

Addresses

Primary practice location

23425 Commerce Park
Suite 104
Beachwood, OH 44122-5844

Mailing address

23425 Commerce Park
Suite 104
Beachwood, OH 44122-5844
Phone (216) 831-2900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170530001838 OH Part B Supplier - Clinic/Group Practice 3072880715 Receives reassigned benefits from 12 practitioners
Practice locations: Beachwood, OH

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1489363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489363200000",
    "number": "1396286191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23425 COMMERCE PARK",
            "address_2": "SUITE 104",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441225844",
            "telephone_number": "216-831-2900",
            "fax_number": "216-831-4306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23425 COMMERCE PARK",
            "address_2": "SUITE 104",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441225844",
            "telephone_number": "216-831-2900",
            "fax_number": "216-831-4306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEBALZO ELGUDIN LEVINE RISEN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-13",
        "last_updated": "2017-03-13",
        "status": "A",
        "authorized_official_last_name": "ELGUDIN",
        "authorized_official_first_name": "LARISSA",
        "authorized_official_title_or_position": "CO-DIRECTOR",
        "authorized_official_telephone_number": "216-831-2900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beachwood, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.