NPIMap

Organization Active NPI

Pinnacle Treatment Centers Oh-XII, LLC

Doing business as Sandusky Treatment Services

  • Methadone Clinic
  • Sandusky, OH
National Provider Identifier
1790301869
Registry record updated Jun 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
Legal business name
PINNACLE TREATMENT CENTERS OH-XII, LLC
Doing business as
Sandusky Treatment Services
Practice address
1036 Cleveland Rd
Sandusky, OH 44870-4034
Phone
(419) 504-0068
NPI assigned
Jun 24, 2020
Last updated
Jun 24, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2020

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

Authorized official

Name
Robyn Tanis
Title
Executive Director of Contract MGMT
Phone
(856) 533-8762

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X NU Primary
Recovery Care Clinic/Center 261QR0800X NU

Addresses

Primary practice location

1036 Cleveland Rd
Sandusky, OH 44870-4034

Mailing address

1317 Route 73 Ste 200
Mount Laurel, NJ 08054-2202
Phone (856) 439-6111

Other names 1

  • Sandusky Treatment Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Opioid treatment program
Medicare-enrolled since Jan 1, 2022

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220519000666 OH Part B Supplier - Opioid Treatment Program (Otp) 4789097981 Practice locations: Sandusky, OH

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
36D2181568Pinnacle Treatment Centers Oh-XII, LLC1036 Cleveland Road, Sandusky, OH 44870Certificate of waiverApr 6, 2028

National Provider Directory

National Provider Directory

Locations

1036 Cleveland Rd
Sandusky, OH 44870
Phone (419) 504-0068

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1592956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592956800000",
    "number": "1790301869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1317 ROUTE 73 STE 200",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080542202",
            "telephone_number": "856-439-6111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1036 CLEVELAND RD",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448704034",
            "telephone_number": "419-504-0068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINNACLE TREATMENT CENTERS OH-XII, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-24",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A",
        "authorized_official_last_name": "TANIS",
        "authorized_official_first_name": "ROBYN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR OF CONTRACT MGMT",
        "authorized_official_telephone_number": "856-533-8762"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Recovery Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sandusky Treatment Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sandusky, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2020; 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.

Verify at the official NPI Registry.