Individual provider Active NPI

Sandy Vasquez-Garcia

  • Addiction (Substance Use Disorder) Counselor
  • Chardon, OH
National Provider Identifier
1497366827
Registry record updated Dec 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
C.2204568 Issued in OH
Practice address
12557 Ravenwood Dr
Chardon, OH 44024-9009
Phone
(440) 285-3568
NPI assigned
Aug 10, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X C.2103428-TRNE OH
Student in an Organized Health Care Education/Training Program 390200000X C.2103428-TRNE OH
Addiction (Substance Use Disorder) Counselor 101YA0400X C.2204568 OH Primary

Addresses

Primary practice location

12557 Ravenwood Dr
Chardon, OH 44024-9009

Mailing address

12557 Ravenwood Dr
Chardon, OH 44024-9009
Phone (440) 285-3568

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241121001683 OH Practitioner - Mental Health Counselor 8921533480 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ravenwood Mental Health CenterGroup PAC ID 6901813922, 57 clinicians

Practice addresses (Care Compare)

12557 Ravenwood Dr
Chardon, OH 44024-9009
Phone (440) 285-3568

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
C.2204568OHMDAddiction (Substance Use Disorder) Counselor
C.2103428-TRNEOHMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Ravenwood Mental Health Center Current Accepting new patients
Ravenwood Mental Health Center Addiction (Substance Use Disorder) CurrentSince Oct 16, 2024 Accepting new patients
Ravenwood Mental Health Center CurrentSince Oct 16, 2024 Accepting new patients

Locations

12557 Ravenwood Dr
Concord Twp, OH 44024
Phone (440) 990-6104

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/ravenwoodhealth/r4/

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1597017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669939200000",
    "number": "1497366827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12557 RAVENWOOD DR",
            "city": "CHARDON",
            "state": "OH",
            "postal_code": "440249009",
            "telephone_number": "440-285-3568",
            "fax_number": "440-632-5277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12557 RAVENWOOD DR",
            "city": "CHARDON",
            "state": "OH",
            "postal_code": "440249009",
            "telephone_number": "440-285-3568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VASQUEZ-GARCIA",
        "first_name": "SANDY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-10",
        "last_updated": "2022-12-02",
        "certification_date": "2022-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "C.2103428-TRNE",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": "C.2103428-TRNE",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "C.2204568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chardon, OH

Sources for this page

Verify at the official NPI Registry.