NPIMap

Organization Active NPI

Jerome M Privitera DPM, Inc.

  • Foot & Ankle Surgery Podiatrist
  • Mentor, OH
National Provider Identifier
1700969102
Registry record updated Oct 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
OH002454 Issued in OH
Legal business name
JEROME M PRIVITERA DPM, INC.
Practice address
9485 Mentor Ave
Suite 200
Mentor, OH 44060-8723
Phone
(440) 205-5878
Fax
(440) 205-5875
NPI assigned
Oct 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2012

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

Authorized official

Name
Jerome M Privitera, DPMNPI 1639173628
Title
Owner
Phone
(440) 205-5878

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Podiatric Medicine PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213EP1101X OH001535 OH
Foot & Ankle Surgery PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213ES0103X OH002454 OH Primary

Addresses

Primary practice location

9485 Mentor Ave
Suite 200
Mentor, OH 44060-8723

Mailing address

9485 Mentor Ave
Suite 200
Mentor, OH 44060-8723
Phone (440) 205-5878

Other identifiers 3

IdentifierTypeStateIssuer
2310654MedicaidOH
2310636MedicaidOH
2310663MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041015000411 OH Part B Supplier - Clinic/Group Practice 0941260715 Receives reassigned benefits from 1 practitioner
Practice locations: Madison, OH; Mentor, OH
O20100930017391 OH DME Supplier - Physician - Podiatry 0941260715 Practice locations: Mentor, OH

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BGBGBA

Practitioners & affiliated clinicians

Practitioners 1

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": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350259200000",
    "number": "1700969102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9485 MENTOR AVE",
            "address_2": "SUITE 200",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440608723",
            "telephone_number": "440-205-5878",
            "fax_number": "440-205-5875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9485 MENTOR AVE",
            "address_2": "SUITE 200",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440608723",
            "telephone_number": "440-205-5878",
            "fax_number": "440-205-5875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEROME M PRIVITERA DPM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2012-10-15",
        "status": "A",
        "authorized_official_last_name": "PRIVITERA",
        "authorized_official_first_name": "JEROME",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "440-205-5878",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213EP1101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "OH",
            "license": "OH001535",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "OH",
            "license": "OH002454",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2310654",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2310636",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2310663",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mentor, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2012; 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.