NPIMap

Organization Active NPI

Southwest General Medical Group

  • Medical Physician Assistant
  • Cleveland, OH
National Provider Identifier
1639610702
Registry record updated Feb 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
50005004 Issued in OH
Legal business name
SOUTHWEST GENERAL MEDICAL GROUP
Practice address
18697 Bagley Rd
Cleveland, OH 44130-3417
Phone
(440) 816-8200
Fax
(440) 816-8197
NPI assigned
Mar 9, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2019

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

Authorized official

Name
Heather Wagner
Title
Executive Director
Phone
(440) 816-4906

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X 50005004 OH Primary

Addresses

Primary practice location

18697 Bagley Rd
Cleveland, OH 44130-3417

Mailing address

PO Box 638269
Cincinnati, OH 45263-8269
Phone (440) 289-2025

National Provider Directory

National Provider Directory
Tax ID family
Strongsville Family Phy6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1489017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551312000000",
    "number": "1639610702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 638269",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452638269",
            "telephone_number": "440-289-2025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18697 BAGLEY RD",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441303417",
            "telephone_number": "440-816-8200",
            "fax_number": "440-816-8197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST GENERAL MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-09",
        "last_updated": "2019-02-28",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "440-816-4906"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "OH",
            "license": "50005004",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Feb 28, 2019; 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.