Individual provider Active NPI

Craig Fischer, CDCA

  • Social Worker
  • Middleburg Heights, OH
National Provider Identifier
1700317849
Registry record updated Feb 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
S.2005350 Issued in OH
Practice address
17535 Rosbough Blvd Ste 202
Middleburg Heights, OH 44130-8362
Phone
(440) 223-9962
Fax
(440) 223-8162
NPI assigned
Mar 21, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X CDCA.161065 OH
Social Worker 104100000X S.2005350 OH Primary

Addresses

Primary practice location

17535 Rosbough Blvd Ste 202
Middleburg Heights, OH 44130-8362

Mailing address

17535 Rosbough Blvd Ste 202
Middleburg Heights, OH 44130-8362
Phone (440) 223-9962

Other identifiers 1

IdentifierTypeStateIssuer
CDCA.161065OtherOHCDCA LICENSE

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
CDCA.161065OHMDAddiction (Substance Use Disorder) Counselor
S.2005350OHMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Revolution Wellness Center LLC CurrentSince Feb 18, 2024 Accepting new patients

Locations

17535 Rosbough Blvd
Ste 202
Middleburg Heights, OH 44130
Phone (216) 772-3310

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": "1490054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708041600000",
    "number": "1700317849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17535 ROSBOUGH BLVD STE 202",
            "city": "MIDDLEBURG HEIGHTS",
            "state": "OH",
            "postal_code": "441308362",
            "telephone_number": "440-223-9962",
            "fax_number": "440-223-8162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17535 ROSBOUGH BLVD STE 202",
            "city": "MIDDLEBURG HEIGHTS",
            "state": "OH",
            "postal_code": "441308362",
            "telephone_number": "440-223-9962",
            "fax_number": "440-223-8162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISCHER",
        "first_name": "CRAIG",
        "credential": "CDCA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-03-21",
        "last_updated": "2024-02-16",
        "certification_date": "2024-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "CDCA.161065",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S.2005350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDCA LICENSE",
            "identifier": "CDCA.161065",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Middleburg Heights, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2024; 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.