Active NPI
Marymount Hospital, Inc.
- Anatomic Pathology & Clinical Pathology Physician
- Garfield Heights, OH
National Provider Identifier
1720031131
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- Legal business name
- MARYMOUNT HOSPITAL, INC.
- Practice address
- 12300 McCracken Rd
Garfield Heights, OH 44125-2914 - Phone
- (216) 587-8686
- Fax
- (216) 587-8274
- NPI assigned
- May 18, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dennis Laraway
- Title
- Executive VP Chief Finance Officer
- Phone
- (216) 445-1343
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | Primary |
Addresses
Primary practice location
12300 McCracken Rd
Garfield Heights, OH 44125-2914
Mailing address
12300 McCracken Rd
Garfield HTS, OH 44125-2914
Phone (216) 587-8146
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2141677 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031217000026 | OH | Part B Supplier - Clinic/Group Practice | 6507763661 |
Receives reassigned benefits from 27 practitioners 1 other NPI on this enrollment Practice locations: Garfield Heights, OH; Garfield HTS, OH |
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- General Acute Care Hospital
- Garfield Heights, OH
- NPI 1942248737
O20031217000026
National Provider Directory
National Provider DirectoryMember organizations 1
Organizations listed as members of this organization in the National Provider Directory.
-
- Family Medicine Physician
- Independence, OH
- NPI 1902097751
Member Of
Practitioners & affiliated clinicians
Practitioners 34
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": "1147910400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1756080000000",
"number": "1720031131",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12300 MCCRACKEN RD",
"city": "GARFIELD HTS",
"state": "OH",
"postal_code": "441252914",
"telephone_number": "216-587-8146",
"fax_number": "216-587-8831"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12300 MCCRACKEN RD",
"city": "GARFIELD HEIGHTS",
"state": "OH",
"postal_code": "441252914",
"telephone_number": "216-587-8686",
"fax_number": "216-587-8274"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MARYMOUNT HOSPITAL, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-18",
"last_updated": "2025-08-25",
"certification_date": "2025-08-25",
"status": "A",
"authorized_official_last_name": "LARAWAY",
"authorized_official_first_name": "DENNIS",
"authorized_official_title_or_position": "EXECUTIVE VP CHIEF FINANCE OFFICER",
"authorized_official_telephone_number": "216-445-1343"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2141677",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Garfield Heights, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2025; 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.