North Shore Pedorthics, LLC

Primary specialty

OrthotistTaxonomy code 222Z00000X

License

LO 228 LPED 029 Issued in OH

Legal business name

NORTH SHORE PEDORTHICS, LLC

Practice address

4370 Oberlin Ave
Suite B
Lorain, OH 44053-2942

Phone

(440) 989-2799

Fax

(440) 989-1127

NPI assigned

Oct 30, 2007

Organization subpart

No

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

Authorized official

Name

Dean A. Mason, CPED, BOCO CO

Title

Single Member

Phone

(440) 989-2799

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1193702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436832000000",
    "number": "1508045238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4370 OBERLIN AVE",
            "address_2": "SUITE B",
            "city": "LORAIN",
            "state": "OH",
            "postal_code": "440532942",
            "telephone_number": "440-989-2799",
            "fax_number": "440-989-1127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4370 OBERLIN AVE",
            "address_2": "SUITE B",
            "city": "LORAIN",
            "state": "OH",
            "postal_code": "440532942",
            "telephone_number": "440-989-2799",
            "fax_number": "440-989-1127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE PEDORTHICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-30",
        "last_updated": "2015-07-14",
        "status": "A",
        "authorized_official_last_name": "MASON",
        "authorized_official_first_name": "DEAN",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "SINGLE MEMBER",
        "authorized_official_telephone_number": "440-989-2799",
        "authorized_official_credential": "CPED, BOCO CO"
    },
    "taxonomies": [
        {
            "code": "222Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthotist",
            "state": "OH",
            "license": "LO 228  LPED 029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2068622",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.