Active NPI
Mitchell Wax
- Psychologist
- Lakewood, OH
National Provider Identifier
1417912510
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 3036
- Practice address
- 13535 Detroit Ave
Ste 5
Lakewood, OH 44107-4625 - Phone
- (216) 221-6260
- NPI assigned
- Apr 20, 2006
- Last updated
- Mar 15, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 3036 | OH | Primary |
Addresses
Primary practice location
13535 Detroit Ave
Ste 5
Lakewood, OH 44107-4625
Mailing address
13535 Detroit Ave
Ste 5
Lakewood, OH 44107-4625
Phone (216) 221-6260
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: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120614000511 | OH | Practitioner - Clinical Psychologist | 0749448033 | Practice locations: Lakewood, OH |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1977
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
13535 Detroit Ave
Lakewood, OH 44107-4625
Phone (216) 221-6260
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3036 | OH | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489536000000",
"number": "1417912510",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13535 DETROIT AVE",
"address_2": "STE 5",
"city": "LAKEWOOD",
"state": "OH",
"postal_code": "441074625",
"telephone_number": "216-221-6260"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13535 DETROIT AVE",
"address_2": "STE 5",
"city": "LAKEWOOD",
"state": "OH",
"postal_code": "441074625",
"telephone_number": "216-221-6260"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAX",
"first_name": "MITCHELL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-20",
"last_updated": "2017-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OH",
"license": "3036",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.