NPIMap

Organization Active NPI

Superior Urgent Care, LLC.

  • Urgent Care Clinic/Center
  • Canal Winchester, OH
National Provider Identifier
1790269751
Registry record updated Apr 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
SUPERIOR URGENT CARE, LLC.
Practice address
3620 Gender Rd
Canal Winchester, OH 43110-8679
Phone
(614) 829-3015
NPI assigned
Sep 17, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2021

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

Authorized official

Name
Stan Bulanov, CNPNPI 1841719580
Title
Owner
Phone
(614) 829-3015

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0401X
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

3620 Gender Rd
Canal Winchester, OH 43110-8679

Mailing address

3620 Gender Rd
Canal Winchester, OH 43110-8679
Phone (614) 829-3015

Other identifiers 1

IdentifierTypeStateIssuer
0328904MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190307001792 OH Part B Supplier - Clinic/Group Practice 6305185497 Receives reassigned benefits from 9 practitioners
1 other NPI on this enrollment
Practice locations: Canal Winchester, OH; Pickerington, OH

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Superior Urgent Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

3620 Gender Rd
Canal Wnchstr, OH 43110
Phone (614) 202-0310

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1537142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617753600000",
    "number": "1790269751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3620 GENDER RD",
            "city": "CANAL WINCHESTER",
            "state": "OH",
            "postal_code": "431108679",
            "telephone_number": "614-829-3015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3620 GENDER RD",
            "city": "CANAL WINCHESTER",
            "state": "OH",
            "postal_code": "431108679",
            "telephone_number": "614-829-3015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERIOR URGENT CARE, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-17",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A",
        "authorized_official_last_name": "BULANOV",
        "authorized_official_first_name": "STAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "614-829-3015",
        "authorized_official_credential": "CNP"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0328904",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canal Winchester, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2021; 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.