NPIMap

Organization Active NPI

Ohioguidestone

  • Developmental - Behavioral Pediatrics Physician
  • Berea, OH
National Provider Identifier
1609123728
Registry record updated Nov 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X
Legal business name
OHIOGUIDESTONE
Practice address
202 E Bagley Rd
Berea, OH 44017-2058
Phone
(440) 260-8379
NPI assigned
Aug 8, 2012
Last updated
Nov 20, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2017

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

Authorized official

Name
Mandy Jackson
Title
Billing Supervisor
Phone
(440) 260-8328

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental - Behavioral Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0006X Primary

Addresses

Primary practice location

202 E Bagley Rd
Berea, OH 44017-2058

Mailing address

434 Eastland Road
Berea, OH 44017-2058
Phone (440) 260-8327

Other names 1

  • Guidestone Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130308000507 OH Part B Supplier - Clinic/Group Practice 5597910935 Receives reassigned benefits from 208 practitioners
3 other NPIs on this enrollment
Practice locations: New Philadelphia, OH; Lancaster, OH; Napoleon, OH; Medina, OH; Marion, OH; Lorain, OH; Bryan, OH; Oberlin, OH…

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Guidestone20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

Locations

401 Tuscarawas St W
Ste 501
Canton, OH 44702
Phone (330) 840-1206

195 N Grant Ave
Ste 250
Columbus, OH 43215
Phone (440) 260-6408

Practitioners & affiliated clinicians

Practitioners 224

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 224

NPI Registry JSON

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

{
    "created_epoch": "1344384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1511136000000",
    "number": "1609123728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "434 EASTLAND ROAD",
            "city": "BEREA",
            "state": "OH",
            "postal_code": "440172058",
            "telephone_number": "440-260-8327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 E BAGLEY RD",
            "city": "BEREA",
            "state": "OH",
            "postal_code": "440172058",
            "telephone_number": "440-260-8379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OHIOGUIDESTONE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-08",
        "last_updated": "2017-11-20",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MANDY",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "440-260-8328"
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Guidestone",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Berea, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 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.