Active NPI
Matthew J Kaminski, PEER SUPPORT
- Peer Specialist
- Cleveland, OH
National Provider Identifier
1669946471
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 0064
- Practice address
- 3637 Green Rd Ste 3G
Cleveland, OH 44122-5717 - Phone
- (216) 220-8774
- NPI assigned
- Jan 15, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 0064 | OH | Primary |
Addresses
Primary practice location
3637 Green Rd Ste 3G
Cleveland, OH 44122-5717
Mailing address
3637 Green Rd Ste 3G
Cleveland, OH 44122-5717
Phone (216) 220-8774
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0064 | OH | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1547510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1547510400000",
"number": "1669946471",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3637 GREEN RD STE 3G",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441225717",
"telephone_number": "216-220-8774"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3637 GREEN RD STE 3G",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441225717",
"telephone_number": "216-220-8774"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KAMINSKI",
"first_name": "MATTHEW",
"middle_name": "J",
"credential": "PEER SUPPORT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-01-15",
"last_updated": "2019-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OH",
"license": "0064",
"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 Jan 15, 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.