Active NPI
Dennis Richard Olivares, PA-C
- Physician Assistant
- Cleveland, OH
National Provider Identifier
1730276239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 50.000644
- Practice address
- 10701 East Blvd
Cleveland, OH 44106-1702 - Phone
- (216) 791-3800
- NPI assigned
- Oct 6, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 50.000644 | OH | Primary |
Addresses
Primary practice location
10701 East Blvd
Cleveland, OH 44106-1702
Mailing address
18433 Main St
Strongsville, OH 44149-1507
Phone (216) 791-3800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221027002469 | OH | Order and Referring Only - Physician Assistant | 1850768276 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50.000644 | OH | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1730276239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18433 MAIN ST",
"city": "STRONGSVILLE",
"state": "OH",
"postal_code": "441491507",
"telephone_number": "216-791-3800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10701 EAST BLVD",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441061702",
"telephone_number": "216-791-3800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLIVARES",
"first_name": "DENNIS",
"middle_name": "RICHARD",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OH",
"license": "50.000644",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.