Individual provider Active NPI

Beth B Sersig, M.D.

  • Family Medicine Physician
  • Cleveland, OH
National Provider Identifier
1588787329
Registry record updated Jun 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35-05-1030-S Issued in OH
Practice address
9501 Euclid Ave
Cleveland, OH 44106-4711
Phone
(216) 368-2000
NPI assigned
Apr 9, 2007
Last updated
Jun 5, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35.051030 OH
Family Medicine Physician 207Q00000X 35-05-1030-S OH Primary

Addresses

Primary practice location

9501 Euclid Ave
Cleveland, OH 44106-4711

Mailing address

2955 Fairfax Rd
Cleveland Heights, OH 44118-4015

Other practice location 1

10900 Euclid Ave.
CWRU Health Services
Cleveland, OH 44106-4901
Phone (216) 368-2450 ext. 4488

Other identifiers 1

IdentifierTypeStateIssuer
35-05-1030-SOtherOHSTATE LICENSE NUMBER

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
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35.051030OHMDFamily Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591315200000",
    "number": "1588787329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2955 FAIRFAX RD",
            "city": "CLEVELAND HEIGHTS",
            "state": "OH",
            "postal_code": "441184015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9501 EUCLID AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441064711",
            "telephone_number": "216-368-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10900 Euclid Ave.",
            "address_2": "CWRU Health Services",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441064901",
            "country_code": "US",
            "telephone_number": "216-368-2450 x4488",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SERSIG",
        "first_name": "BETH",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-09",
        "last_updated": "2020-06-05",
        "certification_date": "2020-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.051030",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35-05-1030-S",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "35-05-1030-S",
            "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 Jun 5, 2020; 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.