NPIMap

Organization Active NPI

Lorain County Health & Dentistry

  • Federally Qualified Health Center (FQHC)
  • Elyria, OH
National Provider Identifier
1720485659
Registry record updated Nov 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LORAIN COUNTY HEALTH & DENTISTRY
Practice address
105 Louden CT
Elyria, OH 44035-8028
Phone
(440) 240-1655
Fax
(440) 240-1218
NPI assigned
Nov 20, 2014
Last updated
Nov 20, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2014

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

Authorized official

Name
Stephanie Wiersma
Title
Ceo
Phone
(440) 233-0159

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Nurse Practitioner 363L00000X
Pediatric Nurse Practitioner 363LP0200X
Primary Care Nurse Practitioner 363LP2300X
Family Medicine Physician 207Q00000X
Adult Medicine Physician 207QA0505X
Internal Medicine Physician 207R00000X
Obstetrics & Gynecology Physician 207V00000X
Pediatrics Physician 208000000X

Addresses

Primary practice location

105 Louden CT
Elyria, OH 44035-8028

Mailing address

1205 Broadway
Lorain, OH 44052-3409
Phone (440) 240-1655

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150130000829 OH Part A Provider - Federally Qualified Health Center (FQHC) 9234047853 Practice locations: Elyria, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720485659. Details of each certification follow.

Federally qualified health center certification: CCN 361063

Legal name
LORAIN COUNTY HEALTH & DENTISTRY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 23, 2015
Last certification
Jan 23, 2015
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jan 30, 2001 in OH
Enrollment address
105 Louden CT
Elyria, OH 44035-8027
Related CCNs
361884

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Lorain County Health Denti26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Eric W Scwarz Individual Corporate DirectorBoard Member May 26, 2015
Todd H Tilberg Individual Corporate DirectorBoard Member Sep 23, 2003
David H Hall Individual Corporate DirectorBoard Member Feb 4, 2020
Cathy Heck Individual Corporate DirectorBoard Member Mar 16, 2021
Ben Kosewski Individual Contracted Managing EmployeeCeo Mar 1, 2025
Corporate OfficerCeo Mar 1, 2025
Reuben Figueroa Individual Corporate DirectorBoard Member Feb 24, 2020
Lisa M Hemker Individual Corporate OfficerCfo Nov 23, 2009
W-2 Managing EmployeeCfo Nov 23, 2009
Lisa M Brown Individual Corporate DirectorBoard Member Oct 28, 2013
Nali Ivey Individual Corporate DirectorBoard Member Feb 26, 2002
Melissa Velez Individual Corporate DirectorBoard Member May 19, 2020
Robyn Mwila Individual Corporate DirectorBoard Member Jul 20, 2021

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1416441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416441600000",
    "number": "1720485659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 BROADWAY",
            "city": "LORAIN",
            "state": "OH",
            "postal_code": "440523409",
            "telephone_number": "440-240-1655",
            "fax_number": "440-245-1218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 LOUDEN CT",
            "city": "ELYRIA",
            "state": "OH",
            "postal_code": "440358028",
            "telephone_number": "440-240-1655",
            "fax_number": "440-240-1218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LORAIN COUNTY HEALTH & DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-20",
        "last_updated": "2014-11-20",
        "status": "A",
        "authorized_official_last_name": "WIERSMA",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "440-233-0159"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elyria, OH

Sources for this page

Verify at the official NPI Registry.