NPIMap

Organization Active NPI

Ridgepark Medical Associates, Inc.

  • Clinical Medical Laboratory
  • Brooklyn, OH
National Provider Identifier
1407865488
Registry record updated Aug 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
36D0338463 Issued in OH
Legal business name
RIDGEPARK MEDICAL ASSOCIATES, INC.
Practice address
7575 Northcliff Ave
Laboratory Suite 106
Brooklyn, OH 44144-3267
Phone
(216) 398-5095
Fax
(216) 398-5119
NPI assigned
Aug 7, 2006
Last updated
Aug 31, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2011

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

Authorized official

Name
Charles Robert Koepke, M.D.NPI 1518951193
Title
President
Phone
(216) 749-8256

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
Clinical Medical Laboratory 291U00000X 36D0338463 OH Primary

Addresses

Primary practice location

7575 Northcliff Ave
Laboratory Suite 106
Brooklyn, OH 44144-3267

Mailing address

7575 Northcliff Ave
Laboratory Suite 106
Brooklyn, OH 44144-3267
Phone (216) 398-5095

Other identifiers 3

IdentifierTypeStateIssuer
512593OtherOHWELLCAREOF OH
2754274MedicaidOH
000000561755OtherANTHEM

National Provider Directory

National Provider Directory
Tax ID family
Ridgepark Medical Associates Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

7575 Northcliff Ave
Ste 106
Brooklyn, OH 44144
Phone (216) 398-5095

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314748800000",
    "number": "1407865488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7575 NORTHCLIFF AVE",
            "address_2": "LABORATORY SUITE 106",
            "city": "BROOKLYN",
            "state": "OH",
            "postal_code": "441443267",
            "telephone_number": "216-398-5095",
            "fax_number": "216-398-5119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7575 NORTHCLIFF AVE",
            "address_2": "LABORATORY SUITE 106",
            "city": "BROOKLYN",
            "state": "OH",
            "postal_code": "441443267",
            "telephone_number": "216-398-5095",
            "fax_number": "216-398-5119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIDGEPARK MEDICAL ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-07",
        "last_updated": "2011-08-31",
        "status": "A",
        "authorized_official_last_name": "KOEPKE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "216-749-8256",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "OH",
            "license": "36D0338463",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCAREOF OH",
            "identifier": "512593",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2754274",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000561755",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2011; 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.