NPIMap

Organization Active NPI

Stella Maris, Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Cleveland, OH
National Provider Identifier
1467598391
Registry record updated Oct 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
STELLA MARIS, INC
Practice address
1302 Winslow Avenue
Cleveland, OH 44113-2333
Phone
(216) 781-0550
NPI assigned
Jan 29, 2007
Last updated
Oct 22, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2011

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

Authorized official

Name
Dr. Robert Lee Smith, PH.D.
Title
Executive Director
Phone
(216) 781-0550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X OH Primary

Addresses

Primary practice location

1302 Winslow Avenue
Cleveland, OH 44113-2333

Mailing address

1320 Washington Avenue
Cleveland, OH 44113-2333
Phone (216) 781-0550

Other identifiers 1

IdentifierTypeStateIssuer
12602OtherOHUPI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171108001718 OH Part B Supplier - Clinic/Group Practice 6800165077 Receives reassigned benefits from 4 practitioners
Practice locations: Cleveland, OH

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Stella Maris6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Practitioners & affiliated clinicians

Practitioners 5

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": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319241600000",
    "number": "1467598391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 WASHINGTON AVENUE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441132333",
            "telephone_number": "216-781-0550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1302 WINSLOW AVENUE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441132333",
            "telephone_number": "216-781-0550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STELLA MARIS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2011-10-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "216-781-0550",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPI",
            "identifier": "12602",
            "state": "OH"
        }
    ],
    "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 22, 2011; 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.