NPIMap

Individual provider Active NPI

Suellywn Stewart, MD

  • Family Medicine Physician
  • Johnstown, OH
National Provider Identifier
1679536932
Registry record updated Oct 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35083236 Issued in OH
Practice address
151 Woodgate Dr
Johnstown, OH 43031
Phone
(220) 564-1810
Fax
(220) 564-1811
NPI assigned
Apr 8, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35083236 OH Primary

Addresses

Primary practice location

151 Woodgate Dr
Johnstown, OH 43031

Mailing address

151 Woodgate Drive
Johnstown, OH 43031
Phone (220) 564-1810

Other identifiers 1

IdentifierTypeStateIssuer
2437045MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address stewartclinicalteam@lmhealth.direct-ci.net

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)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35083236OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lima Memorial Joint Operating Company Past Accepting new patients
Dublin Urgent Care Inc Past Accepting new patients
Licking Memorial Professional Corp. Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1144454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603065600000",
    "number": "1679536932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 WOODGATE DRIVE",
            "city": "JOHNSTOWN",
            "state": "OH",
            "postal_code": "43031",
            "telephone_number": "220-564-1810",
            "fax_number": "220-564-1811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 WOODGATE DR",
            "city": "JOHNSTOWN",
            "state": "OH",
            "postal_code": "43031",
            "telephone_number": "220-564-1810",
            "fax_number": "220-564-1811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEWART",
        "first_name": "SUELLYWN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-08",
        "last_updated": "2020-10-19",
        "certification_date": "2020-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35083236",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2437045",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "stewartclinicalteam@lmhealth.direct-ci.net",
            "affiliation": "N",
            "address_1": "151 Woodgate Dr",
            "city": "Johnstown",
            "state": "OH",
            "country_code": "US",
            "postal_code": "43031",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Johnstown, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2020; 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.