NPIMap

Organization Active NPI

Premier Care of Ohio, LLC

Doing business as CMS Cleveland on Brookpark

  • Methadone Clinic
  • Cleveland, OH
National Provider Identifier
1730870163
Registry record updated May 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
Legal business name
PREMIER CARE OF OHIO, LLC
Doing business as
CMS Cleveland on Brookpark
Practice address
6300 Brookpark Rd
Cleveland, OH 44129-1219
Phone
(440) 672-6955
Fax
(216) 331-1175
NPI assigned
May 17, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2024

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

Authorized official

Name
Alex G Vilchis
Title
Credentialing Provider Data Manager
Phone
(602) 248-8886

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Community/Behavioral Health Agency 251S00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Methadone Clinic 261QM2800X Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X

Addresses

Primary practice location

6300 Brookpark Rd
Cleveland, OH 44129-1219

Mailing address

8444 N 90TH St Ste 100
Scottsdale, AZ 85258-4437
Phone (804) 942-4974

Other names 1

  • CMS CLEVELAND ON BROOKPARK Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Opioid treatment program
Medicare-enrolled since Jan 1, 2020

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200508000963 OH Part B Supplier - Opioid Treatment Program (Otp) 7719318690 17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cleveland, OH; Lima, OH; Kettering, OH; Elyria, OH; Columbus, OH; Cincinnati, OH; Akron, OH

Other NPIs on the same Medicare enrollment 17

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 17

National Provider Directory

National Provider Directory

Locations

2020 Carnegie Ave
Cleveland, OH 44115
Phone (216) 241-3210

5 Severance Cir
Ste 101
Cleveland Heights, OH 44118
Phone (216) 691-2369

NPI Registry JSON

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

{
    "created_epoch": "1684281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717027200000",
    "number": "1730870163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8444 N 90TH ST STE 100",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852584437",
            "telephone_number": "804-942-4974",
            "fax_number": "480-687-7361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6300 BROOKPARK RD",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441291219",
            "telephone_number": "440-672-6955",
            "fax_number": "216-331-1175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER CARE OF OHIO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-17",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A",
        "authorized_official_last_name": "VILCHIS",
        "authorized_official_first_name": "ALEX",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CREDENTIALING PROVIDER DATA MANAGER",
        "authorized_official_telephone_number": "602-248-8886"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CMS CLEVELAND ON BROOKPARK",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 May 30, 2024; 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.