NPIMap

Organization Active NPI

Western Reserve Professional Group

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Kent, OH
National Provider Identifier
1780768820
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
Legal business name
WESTERN RESERVE PROFESSIONAL GROUP
Practice address
401 Devon PL
Kent, OH 44240-6482
Phone
(330) 677-3628
Fax
(330) 677-3626
NPI assigned
Oct 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Kelly Semancik
Title
Adiminstrative Director
Phone
(330) 677-3628

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X Primary

Addresses

Primary practice location

401 Devon PL
Kent, OH 44240-6482

Mailing address

307 W Main St
Kent, OH 44240-2400
Phone (330) 677-3628

National Provider Directory

National Provider Directory
Tax ID family
Western Reserve Professional Group5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780768820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 W MAIN ST",
            "city": "KENT",
            "state": "OH",
            "postal_code": "442402400",
            "telephone_number": "330-677-3628",
            "fax_number": "330-677-3626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 DEVON PL",
            "city": "KENT",
            "state": "OH",
            "postal_code": "442406482",
            "telephone_number": "330-677-3628",
            "fax_number": "330-677-3626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN RESERVE PROFESSIONAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SEMANCIK",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "ADIMINSTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "330-677-3628"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kent, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.