NPIMap

Organization Active NPI

Ohio North East Health Systems Inc

  • Federally Qualified Health Center (FQHC)
  • Warren, OH
National Provider Identifier
1790049872
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
OHIO NORTH EAST HEALTH SYSTEMS INC
Practice address
1821 E Market St
Warren, OH 44483-6627
Phone
(330) 392-7000
Fax
(330) 884-6120
NPI assigned
Jul 3, 2012
Last updated
Jun 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Ronald Dwinnells, MDNPI 1902893142
Title
Ceo
Phone
(330) 747-9551

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X NU
Social Worker 104100000X NU
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU
Pediatrics Physician 208000000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1821 E Market St
Warren, OH 44483-6627

Mailing address

726 Wick Ave
Youngstown, OH 44505-2827
Phone (330) 747-9551

Other identifiers 1

IdentifierTypeStateIssuer
0068428MedicaidOH

Other names 2

  • Kidz 1st Pediatrics Other name
  • Market Street Pediatrics Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120822000267 OH Part A Provider - Federally Qualified Health Center (FQHC) 1951395086 Practice locations: Warren, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790049872. Details of each certification follow.

Federally qualified health center certification: CCN 361000

Legal name
OHIO NORTH EAST HEALTH SYSTEMS INC
Doing business as
EAST MARKET PEDIATRICS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 22, 2012
Last certification
Aug 22, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 23, 1989 in OH
Enrollment address
1821 E Market St
Warren, OH 44483-6627

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D2055524Market Street Pediatrics1821 E Market St, Warren, OH 44483Certificate of waiverMar 12, 2027

National Provider Directory

National Provider Directory
Tax ID family
Ohio North East Health Systems Inc23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
William Thornton Individual Corporate DirectorBoard Member Apr 27, 2021
Dan Rupp Individual Corporate DirectorBoard Member Jul 30, 2018
Dennis Kuhns Individual Corporate DirectorBoard Chairman Jul 30, 2018
Judy Eiland Individual Corporate DirectorBoard Member Oct 24, 2017
Susan Montalbano Individual W-2 Managing EmployeeCredentialing Coord. Aug 4, 2014
Ronald Dwinnells Individual Corporate OfficerCeo Jul 1, 1994
Tanya Murphy Individual Corporate DirectorBoard Member Nov 29, 2016
Damon Dohar Individual Corporate DirectorBoard Member Aug 29, 2017
Victor Wan-Tatah Individual Corporate DirectorBoard Member Nov 1, 2002
Tammy Parteleno Individual Corporate DirectorBoard Member Jul 25, 2017
Patricia Rupp Individual Corporate DirectorBoard Member Jul 30, 2018
Rose Marie Pirone Individual Corporate DirectorBoard Member Dec 11, 2018

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1341273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1790049872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "726 WICK AVE",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445052827",
            "telephone_number": "330-747-9551",
            "fax_number": "330-884-6120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1821 E MARKET ST",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444836627",
            "telephone_number": "330-392-7000",
            "fax_number": "330-884-6120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OHIO NORTH EAST HEALTH SYSTEMS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-03",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "DWINNELLS",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "330-747-9551",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0068428",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kidz 1st Pediatrics",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Market Street Pediatrics",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Warren, OH

Sources for this page

Verify at the official NPI Registry.