Individual provider Active NPI

Carmalita R Gendraw

  • Driver
  • Willoughby, OH
National Provider Identifier
1699437772
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DriverTaxonomy code 172A00000X
License
RU778241 Issued in OH
Practice address
38360 Tamarac Blvd Apt 101
Willoughby, OH 44094-8115
Phone
(216) 704-6640
NPI assigned
Oct 6, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Driver 172A00000X RU778241 OH Primary

Addresses

Primary practice location

38360 Tamarac Blvd Apt 101
Willoughby, OH 44094-8115

Mailing address

38360 Tamarac Blvd Apt 101
Willoughby, OH 44094-8115
Phone (216) 704-6640

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

LicenseStateTypeSpecialty
RU778241OHMDDriver

Practice roles

OrganizationSpecialtyStatusNew patients
Carmalita Transport Service; LLC Driver CurrentSince May 4, 2025 Accepting new patients

Organizations & group practices 1

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": "1633478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745884800000",
    "number": "1699437772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38360 TAMARAC BLVD APT 101",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440948115",
            "telephone_number": "216-704-6640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38360 TAMARAC BLVD APT 101",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440948115",
            "telephone_number": "216-704-6640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENDRAW",
        "first_name": "CARMALITA",
        "middle_name": "R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-06",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": "OH",
            "license": "RU778241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willoughby, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2025; 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.