Organization Active NPI

Montefiore Home

  • Nurse Practitioner
  • Beachwood, OH
National Provider Identifier
1700277126
Registry record updated Feb 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
MONTEFIORE HOME
Practice address
One David N Myers Parkway
Beachwood, OH 44122-1162
Phone
(216) 360-9080
NPI assigned
Feb 6, 2015
Organization subpart
Yes
Parent organization
MONTEFIORE HOMEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 6, 2015

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

Authorized official

Name
Mark Weiss
Title
Cfo & VP of Operations
Phone
(216) 910-2640

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

One David N Myers Parkway
Beachwood, OH 44122-1162

Mailing address

One David N Myers Parkway
Beachwood, OH 44122-1162
Phone (216) 360-9080

Other names 1

  • MONTEFIORE PROFESSIONAL SERVICES Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050922001104 OH Part B Supplier - Clinic/Group Practice 4385532357 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Beachwood, OH; Chagrin Falls, OH

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Montefiore Home

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

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": "1423180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423180800000",
    "number": "1700277126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ONE DAVID N MYERS PARKWAY",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441221162",
            "telephone_number": "216-360-9080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ONE DAVID N MYERS PARKWAY",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441221162",
            "telephone_number": "216-360-9080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTEFIORE HOME",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MONTEFIORE HOME",
        "enumeration_date": "2015-02-06",
        "last_updated": "2015-02-06",
        "status": "A",
        "authorized_official_last_name": "WEISS",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CFO & VP OF OPERATIONS",
        "authorized_official_telephone_number": "216-910-2640"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MONTEFIORE PROFESSIONAL SERVICES",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Beachwood, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.