NPIMap

Organization Active NPI

Jewish Family Service Assocation Psychobiology Clinic

  • Community/Behavioral Health Agency
  • Cleveland, OH
National Provider Identifier
1689702573
Registry record updated Dec 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
JEWISH FAMILY SERVICE ASSOCATION PSYCHOBIOLOGY CLINIC
Practice address
12200 Fairhill Rd
Cleveland, OH 44120-1058
Phone
(216) 292-3999
Fax
(216) 292-6313
NPI assigned
Mar 1, 2007
Last updated
Dec 17, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2007

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

Authorized official

Name
David Hlavac
Title
Cfo
Phone
(216) 292-3999

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

12200 Fairhill Rd
Cleveland, OH 44120-1058

Mailing address

3659 Green Rd
Suite 322
Beachwood, OH 44122-5727
Phone (216) 292-3999

Other identifiers 3

IdentifierTypeStateIssuer
0959566MedicaidOH
4618OtherOHOHIO MACSIS MEDICAID
0574061MedicaidOH

National Provider Directory

National Provider Directory
Tax ID family
Jewish Family Service a6 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 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197849600000",
    "number": "1689702573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3659 GREEN RD",
            "address_2": "SUITE 322",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441225727",
            "telephone_number": "216-292-3999",
            "fax_number": "216-292-6313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12200 FAIRHILL RD",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441201058",
            "telephone_number": "216-292-3999",
            "fax_number": "216-292-6313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEWISH FAMILY SERVICE ASSOCATION PSYCHOBIOLOGY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2007-12-17",
        "status": "A",
        "authorized_official_last_name": "HLAVAC",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "216-292-3999"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0959566",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO MACSIS MEDICAID",
            "identifier": "4618",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0574061",
            "state": "OH"
        }
    ],
    "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 Dec 17, 2007; 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.