NPIMap

Organization Active NPI

North Eastern Ohio Podiatry Group LLC

  • Foot & Ankle Surgery Podiatrist
  • Willoughby Hills, OH
National Provider Identifier
1447529656
Registry record updated Jul 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
NORTH EASTERN OHIO PODIATRY GROUP LLC
Practice address
35010 Chardon Rd
Suite 101a
Willoughby Hills, OH 44094-9011
Phone
(440) 953-3668
Fax
(440) 953-3556
NPI assigned
Dec 16, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2012

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

Authorized official

Name
Dr. Vadim Glukh, DPMNPI 1164406195
Title
Partner
Phone
(440) 953-3668

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
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X OH Primary

Addresses

Primary practice location

35010 Chardon Rd
Suite 101a
Willoughby Hills, OH 44094-9011

Mailing address

35010 Chardon Rd
Suite 101a
Willoughby Hills, OH 44094-9011
Phone (440) 953-3668

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120216000518 OH Part B Supplier - Clinic/Group Practice 3072771336 Receives reassigned benefits from 2 practitioners
Practice locations: Beachwood, OH; Euclid, OH; Willoughby Hills, OH
O20120412000109 OH DME Supplier - Physician - Podiatry 3072771336 Practice locations: Willoughby Hills, OH

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
North Eastern Ohio Podiatry3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

25101 Chagrin Blvd
Ste 190
Beachwood, OH 44122
Phone (440) 953-3668

Practitioners & affiliated clinicians

Practitioners 2

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": "1323993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343088000000",
    "number": "1447529656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35010 CHARDON RD",
            "address_2": "SUITE 101A",
            "city": "WILLOUGHBY HILLS",
            "state": "OH",
            "postal_code": "440949011",
            "telephone_number": "440-953-3668",
            "fax_number": "440-953-3556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35010 CHARDON RD",
            "address_2": "SUITE 101A",
            "city": "WILLOUGHBY HILLS",
            "state": "OH",
            "postal_code": "440949011",
            "telephone_number": "440-953-3668",
            "fax_number": "440-953-3556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH EASTERN OHIO PODIATRY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-16",
        "last_updated": "2012-07-24",
        "status": "A",
        "authorized_official_last_name": "GLUKH",
        "authorized_official_first_name": "VADIM",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "440-953-3668",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willoughby Hills, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2012; 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.