NPIMap

Organization Active NPI

Physicians Provider Services,Inc

  • Preferred Provider Organization
  • Cleveland, OH
National Provider Identifier
1609053107
Registry record updated Sep 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
35041190J Issued in OH
Legal business name
PHYSICIANS PROVIDER SERVICES,INC
Practice address
16603 Harvard Ave
Cleveland, OH 44128-2203
Phone
(216) 921-5222
Fax
(216) 921-6421
NPI assigned
Jan 28, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2008

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

Authorized official

Name
Dr. Andrew Jimerson, M.D.NPI 1427056076
Title
Physician
Phone
(216) 921-5222

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X 35041190J OH Primary

Addresses

Primary practice location

16603 Harvard Ave
Cleveland, OH 44128-2203

Mailing address

16603 Harvard Ave
Cleveland, OH 44128-2203
Phone (216) 921-5222

Other identifiers 2

IdentifierTypeStateIssuer
2183622MedicaidOH
0414439MedicaidOH

National Provider Directory

National Provider Directory

Locations

11811 Shaker Blvd
Ste 330
Cleveland, OH 44120
Phone (216) 721-1805

Practitioners & affiliated clinicians

Practitioners 3

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": "1201478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222387200000",
    "number": "1609053107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16603 HARVARD AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441282203",
            "telephone_number": "216-921-5222",
            "fax_number": "216-921-6421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16603 HARVARD AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441282203",
            "telephone_number": "216-921-5222",
            "fax_number": "216-921-6421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS PROVIDER SERVICES,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-28",
        "last_updated": "2008-09-26",
        "status": "A",
        "authorized_official_last_name": "JIMERSON",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "216-921-5222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "OH",
            "license": "35041190J",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2183622",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0414439",
            "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 Sep 26, 2008; 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.