NPIMap

Organization Active NPI

Stella Maris, Inc.

  • Adult Mental Health Clinic/Center
  • Cleveland, OH
National Provider Identifier
1487927802
Registry record updated May 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
0679 Issued in OH
Legal business name
STELLA MARIS, INC.
Practice address
1302 Winslow Ave
Cleveland, OH 44113-2336
Phone
(216) 781-0550
Fax
(216) 781-7501
NPI assigned
Feb 15, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2017

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

Authorized official

Name
Dr. Deborah A. Bridwell, PHD
Title
Executive Director
Phone
(216) 727-2058

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X 0679 OH Primary

Addresses

Primary practice location

1302 Winslow Ave
Cleveland, OH 44113-2336

Mailing address

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

Other names 1

  • Stella Maris Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171108001967 OH Part B Supplier - Clinic/Group Practice 6800165077 Receives reassigned benefits from 3 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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1329264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494892800000",
    "number": "1487927802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 WASHINGTON AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441132333",
            "telephone_number": "216-781-0550",
            "fax_number": "216-781-7501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1302 WINSLOW AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441132336",
            "telephone_number": "216-781-0550",
            "fax_number": "216-781-7501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STELLA MARIS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-15",
        "last_updated": "2017-05-16",
        "status": "A",
        "authorized_official_last_name": "BRIDWELL",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "216-727-2058",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "OH",
            "license": "0679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stella Maris",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 May 16, 2017; 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.