NPIMap

Organization Active NPI

Outreach Professional Services Inc

Doing business as Cuyahoga Physician Network

  • Sports Medicine (Internal Medicine) Physician
  • Solon, OH
National Provider Identifier
1770765380
Registry record updated Jan 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0010X
Legal business name
OUTREACH PROFESSIONAL SERVICES INC
Doing business as
Cuyahoga Physician Network
Practice address
33141 Bainbridge Rd
Solon, OH 44139
Phone
(440) 248-8888
Fax
(440) 349-4026
NPI assigned
Dec 5, 2007
Last updated
Jan 12, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2010

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

Authorized official

Name
Misty A Blaylock
Title
Credentialing Coordinator
Phone
(440) 892-6406

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Internal Medicine) Physician 207RS0010X NU Primary
Orthopaedic Surgery Physician 207X00000X NU
Podiatrist 213E00000X NU

Addresses

Primary practice location

33141 Bainbridge Rd
Solon, OH 44139

Mailing address

26908 Detroit Rd
Suite 301
Westlake, OH 44145-2398
Phone (440) 617-1823

Other identifiers 1

IdentifierTypeStateIssuer
0251856MedicaidOH

Other names 1

  • Cuyahoga Physician Network Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Cuyahoga Physician Network22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1196812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263254400000",
    "number": "1770765380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26908 DETROIT RD",
            "address_2": "SUITE 301",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "441452398",
            "telephone_number": "440-617-1823",
            "fax_number": "440-617-0884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33141 BAINBRIDGE RD",
            "city": "SOLON",
            "state": "OH",
            "postal_code": "44139",
            "telephone_number": "440-248-8888",
            "fax_number": "440-349-4026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTREACH PROFESSIONAL SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-05",
        "last_updated": "2010-01-12",
        "status": "A",
        "authorized_official_last_name": "BLAYLOCK",
        "authorized_official_first_name": "MISTY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "440-892-6406"
    },
    "taxonomies": [
        {
            "code": "207RS0010X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sports Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0251856",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cuyahoga Physician Network",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Solon, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.