NPIMap

Organization Active NPI

Steadfast Health Professional Services of Ohio Inc

  • General Practice Physician
  • Cleveland, OH
National Provider Identifier
1467347278
Registry record updated Oct 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
STEADFAST HEALTH PROFESSIONAL SERVICES OF OHIO INC
Practice address
11201 Shaker Blvd Ste 106
Cleveland, OH 44104-3833
Phone
(866) 935-0936
Fax
(330) 319-7828
NPI assigned
Jun 11, 2025
Last updated
Oct 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2025

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

Authorized official

Name
Davis Stephen, MDNPI 1750769154
Title
Cco
Phone
(479) 422-1581

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

11201 Shaker Blvd Ste 106
Cleveland, OH 44104-3833

Mailing address

11201 Shaker Blvd Ste 106
Cleveland, OH 44104-3833
Phone (866) 935-0936

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251031002224 OH Part B Supplier - Clinic/Group Practice 0648769315 Receives reassigned benefits from 5 practitioners
Practice locations: Cleveland, OH

National Provider Directory

National Provider Directory
Tax ID family
Steadfast Health Professional Services of Ohio 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

11201 Shaker Blvd
Cleveland, OH 44104
Phone (216) 368-7238

11201 Shaker Blvd
Ste 106
Cleveland, OH 44104
Phone (216) 352-6521

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 6

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": "1749600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759795200000",
    "number": "1467347278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11201 SHAKER BLVD STE 106",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441043833",
            "telephone_number": "866-935-0936",
            "fax_number": "330-319-7828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11201 SHAKER BLVD STE 106",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441043833",
            "telephone_number": "866-935-0936",
            "fax_number": "330-319-7828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEADFAST HEALTH PROFESSIONAL SERVICES OF OHIO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-11",
        "last_updated": "2025-10-07",
        "certification_date": "2025-10-07",
        "status": "A",
        "authorized_official_last_name": "STEPHEN",
        "authorized_official_first_name": "DAVIS",
        "authorized_official_title_or_position": "CCO",
        "authorized_official_telephone_number": "479-422-1581",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2025; 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.