NPIMap

Organization Active NPI

Green Road Pediatrics, Inc.

  • Pediatrics Physician
  • South Euclid, OH
National Provider Identifier
1396822847
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
GREEN ROAD PEDIATRICS, INC.
Practice address
1611 S Green Rd
Suite 035
South Euclid, OH 44121-4128
Phone
(216) 382-3800
Fax
(216) 381-5198
NPI assigned
Nov 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. James T. Leslie, M.D.NPI 1144211962
Title
President
Phone
(216) 382-3800

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

1611 S Green Rd
Suite 035
South Euclid, OH 44121-4128

Mailing address

1611 S Green Rd
Suite 035
South Euclid, OH 44121-4128
Phone (216) 382-3800

Other identifiers 1

IdentifierTypeStateIssuer
2129637MedicaidOH

National Provider Directory

National Provider Directory

Locations

1611 S Green Rd
Ste 35
South Euclid, OH 44121
Phone (216) 382-3800

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1396822847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 S GREEN RD",
            "address_2": "SUITE 035",
            "city": "SOUTH EUCLID",
            "state": "OH",
            "postal_code": "441214128",
            "telephone_number": "216-382-3800",
            "fax_number": "216-381-5198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 S GREEN RD",
            "address_2": "SUITE 035",
            "city": "SOUTH EUCLID",
            "state": "OH",
            "postal_code": "441214128",
            "telephone_number": "216-382-3800",
            "fax_number": "216-381-5198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN ROAD PEDIATRICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LESLIE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "216-382-3800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2129637",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Euclid, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.