Active NPI
Tremayne Kellom
- Community/Behavioral Health Agency
- Willoughby Hills, OH
National Provider Identifier
1487142329
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Jan 18, 2024.
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- Practice address
- 2882 Cricket LN
Willoughby Hills, OH 44092-1412 - Phone
- (440) 347-0716
- NPI assigned
- Apr 26, 2018
- Last updated
- Apr 26, 2018
- 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 |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Primary |
Addresses
Primary practice location
2882 Cricket LN
Willoughby Hills, OH 44092-1412
Mailing address
2882 Cricket LN
Willoughby Hills, OH 44092-1412
Phone (440) 347-0716
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1524700800000",
"number": "1487142329",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2882 CRICKET LN",
"city": "WILLOUGHBY HILLS",
"state": "OH",
"postal_code": "440921412",
"telephone_number": "440-347-0716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2882 CRICKET LN",
"city": "WILLOUGHBY HILLS",
"state": "OH",
"postal_code": "440921412",
"telephone_number": "440-347-0716"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLOM",
"first_name": "TREMAYNE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-04-26",
"last_updated": "2018-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": null,
"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 Apr 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.