NPIMap

Organization Active NPI

Crystal Clinic Orthopaedic Center, LLC

  • Special Hospital
  • Medina, OH
National Provider Identifier
1801032503
Registry record updated Oct 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Special HospitalTaxonomy code 284300000X
Legal business name
CRYSTAL CLINIC ORTHOPAEDIC CENTER, LLC
Practice address
4975 Foote Rd
Suite 100
Medina, OH 44256-8748
Phone
(330) 721-8232
Fax
(330) 721-8403
NPI assigned
Dec 30, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2021

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

Authorized official

Name
Mr. Daniel J Ferry
Title
President/Ceo
Phone
(330) 670-4152

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Special Hospital 284300000X Primary

Addresses

Primary practice location

4975 Foote Rd
Suite 100
Medina, OH 44256-8748

Mailing address

PO Box 72434
Cleveland, OH 44192-0002
Phone (330) 668-7428

Other names 1

  • Crystal Clinic Orthopaedic Center - Medina Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20081010000570 OH Part A Provider - Hospital 6507934015 14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kent, OH; Wadsworth, OH; Medina, OH; Independence, OH; Hudson, OH; Cuyahoga Falls, OH; Canton, OH; Barberton, OH…
O20100930098077 OH DME Supplier - HospitalDME Supplier - Physician - Orthopedic/Orthopedic Surgery 6507934015 Practice locations: Medina, OH

Hospital certification: CCN 360351

Legal name
CRYSTAL CLINIC ORTHOPAEDIC CENTER, LLC
Doing business as
CRYSTAL CLINIC ORTHOPAEDIC CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jun 19, 2009
Last certification
Jun 19, 2009
Beds
94
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
Aug 14, 2007 in OH
Enrollment address
3557 Embassy Pkwy
Akron, OH 44333-8358
Main/Primary Hospital Location
Hospital subgroups
Specialty hospital

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 11

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Crystal Clinic Orthopaedic CenterCCN 360351
Overall star rating
5 of 5
Type
Acute Care Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Rajiv Taliwal Individual Corporate OfficerSecretary/Treasurer, Board Member Jan 1, 2015
Ian M Gradisar Individual Corporate DirectorBoard Member Jan 1, 2015
Crystal Clinic Surgery Center, LLC Organization, Akron, OH LLC, Investment firm 5% Or Greater Direct Ownership Interest May 27, 2009 36.46%
Christopher Trella Individual Contracted Managing EmployeeCfo Mar 28, 2022
Nathan a Monaco Individual Corporate DirectorBoard Member Jan 1, 2024
William F Scully Individual Corporate DirectorBoard Member Jan 1, 2024
Derek G Cody Individual Corporate DirectorBoard Member Jan 1, 2021
Daniel Ferry Individual Contracted Managing EmployeePresident/Ceo Dec 1, 2016
Corporate Officer Dec 1, 2016
Curtis R Noel Individual Corporate DirectorSecretary Jan 18, 2021
Paul R Fleissner Individual Corporate DirectorChairman of the Board Aug 18, 2021
Carrie Diulus Individual Corporate DirectorBoard Member Jan 1, 2020
Crystal Clinic, Inc. Organization, Akron, OH Corporation, Medical provider/supplier 5% Or Greater Direct Ownership Interest May 27, 2009 13.89%
Kyle Nelman Individual Corporate DirectorBoard Member Jan 1, 2020
Terrence G Deis Individual Contracted Managing EmployeeChief Administrative Officer Dec 6, 2021
GBS Ccoc, LLC Organization, North Canton, OH Created for acquisition, LLC, Holding company 5% Or Greater Direct Ownership Interest Nov 30, 2014 49.65%

Owners & managing parties with NPI records 10

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

Practitioners & affiliated clinicians

Practitioners 41

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

View all 41

Affiliated clinicians 213

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 213

NPI Registry JSON

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

{
    "created_epoch": "1230595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634083200000",
    "number": "1801032503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 72434",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441920002",
            "telephone_number": "330-668-7428",
            "fax_number": "330-666-2709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4975 FOOTE RD",
            "address_2": "SUITE 100",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442568748",
            "telephone_number": "330-721-8232",
            "fax_number": "330-721-8403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL CLINIC ORTHOPAEDIC CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-30",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A",
        "authorized_official_last_name": "FERRY",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "330-670-4152",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "284300000X",
            "taxonomy_group": "",
            "desc": "Special Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crystal Clinic Orthopaedic Center - Medina",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Crystal Clinic Orthopaedic Center - Medina",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Medina, OH

Sources for this page

Verify at the official NPI Registry.