NPIMap

Organization Active NPI

Trumbull Mahoning Medical Group Inc

Doing business as TMMG Urgent Care

  • Family Medicine Physician
  • Cortland, OH
National Provider Identifier
1639332240
Registry record updated Jan 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
TRUMBULL MAHONING MEDICAL GROUP INC
Doing business as
TMMG Urgent Care
Practice address
2600 Elm Rd NE
Cortland, OH 44410-9393
Phone
(330) 372-8820
Fax
(330) 372-8999
NPI assigned
Jul 3, 2008
Organization subpart
Yes
Parent organization
TRUMBULL MAHONING MEDICAL GROUP INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 17, 2014

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

Authorized official

Name
Mourad Rostom, MD
Title
Partner/Executive
Phone
(330) 372-8820

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

2600 Elm Rd NE
Cortland, OH 44410-9393

Mailing address

2600 Elm Road NE
Cortland, OH 44410
Phone (330) 372-8895

Other identifiers 3

IdentifierTypeStateIssuer
0468677MedicaidOH
1426141OtherPAHIGHMARK OF PA
000000243183OtherOHANTHEM

Other names 1

  • TMMG Urgent Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050309000599 OH Part B Supplier - Clinic/Group Practice 3779537022 Receives reassigned benefits from 7 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cortland, OH; Youngstown, OH

Other NPIs on the same Medicare enrollment 4

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D2002260TMMG Urgent Care2600 Elm Road Building D, Cortland, OH 44410Certificate of waiverJan 11, 2028

National Provider Directory

National Provider Directory
Tax ID family
Trumbull Mahoning Medical Group Inc4 organizations share this tax ID, including this one
Part of
Trumbull Mahoning Medical Group Inc

Other organizations with this tax ID 3

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

Practitioners & affiliated clinicians

Practitioners 2

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": "1215043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389916800000",
    "number": "1639332240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 ELM ROAD NE",
            "city": "CORTLAND",
            "state": "OH",
            "postal_code": "44410",
            "telephone_number": "330-372-8895",
            "fax_number": "330-372-8999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 ELM RD NE",
            "city": "CORTLAND",
            "state": "OH",
            "postal_code": "444109393",
            "telephone_number": "330-372-8820",
            "fax_number": "330-372-8999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRUMBULL MAHONING MEDICAL GROUP INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRUMBULL MAHONING MEDICAL GROUP INC",
        "enumeration_date": "2008-07-03",
        "last_updated": "2014-01-17",
        "status": "A",
        "authorized_official_last_name": "ROSTOM",
        "authorized_official_first_name": "MOURAD",
        "authorized_official_title_or_position": "PARTNER/EXECUTIVE",
        "authorized_official_telephone_number": "330-372-8820",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0468677",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK OF PA",
            "identifier": "1426141",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000243183",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TMMG Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cortland, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.