Active NPI
Lake Effect Health
- Nurse Practitioner
- Cleveland, OH
National Provider Identifier
1780156984
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- Legal business name
- LAKE EFFECT HEALTH
- Practice address
- 3611 Prospect Ave E
Cleveland, OH 44115-2703 - Phone
- (440) 289-7584
- Fax
- (216) 331-6751
- NPI assigned
- Dec 28, 2018
- 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
- Ms. Seana Rutherford, APRN
- Title
- Owner/Operator
- Phone
- (216) 704-1425
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | Primary |
Addresses
Primary practice location
3611 Prospect Ave E
Cleveland, OH 44115-2703
Mailing address
3611 Prospect Ave E
Cleveland, OH 44115-2703
Phone (440) 289-7584
Other practice location 1
7575 Northcliff Ave Ste 103
Brooklyn, OH 44144-3267
Phone (216) 205-4862
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0142912 | 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 |
|---|---|---|---|---|
| O20190312003664 | OH | Part B Supplier - Clinic/Group Practice | 4688914518 |
Receives reassigned benefits from 13 practitioners Practice locations: Cleveland, OH |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 36D2161020 | Lake Effect Health LLC | Certificate of waiver | Jan 23, 2027 |
National Provider Directory
National Provider DirectoryLocations
4000 Golden Age Dr
Batavia, OH 45103
Phone (513) 732-6500
7575 Northcliff Ave
#103
Brooklyn, OH 44144
Phone (216) 331-6750
Practitioners & affiliated clinicians
Practitioners 71
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Nurse Practitioner
- Cleveland, OH
- NPI 1851036560
-
- Nurse Practitioner
- Brooklyn, OH
- NPI 1942916093
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1545955200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1726444800000",
"number": "1780156984",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3611 PROSPECT AVE E",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441152703",
"telephone_number": "440-289-7584",
"fax_number": "216-331-6751"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3611 PROSPECT AVE E",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441152703",
"telephone_number": "440-289-7584",
"fax_number": "216-331-6751"
}
],
"practiceLocations": [
{
"address_1": "7575 Northcliff Ave Ste 103",
"address_purpose": "LOCATION",
"city": "Brooklyn",
"state": "OH",
"postal_code": "441443267",
"country_code": "US",
"telephone_number": "216-205-4862",
"fax_number": "216-205-4767",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "LAKE EFFECT HEALTH",
"organizational_subpart": "NO",
"enumeration_date": "2018-12-28",
"last_updated": "2024-09-16",
"certification_date": "2024-09-16",
"status": "A",
"authorized_official_last_name": "RUTHERFORD",
"authorized_official_first_name": "SEANA",
"authorized_official_title_or_position": "OWNER/OPERATOR",
"authorized_official_telephone_number": "216-704-1425",
"authorized_official_name_prefix": "Ms.",
"authorized_official_credential": "APRN"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0142912",
"state": "OH"
}
],
"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 Sep 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.