Active NPI
David Ellis Radebaugh, M.D.
- Diagnostic Radiology Physician
- Parma, OH
National Provider Identifier
1801996277
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 35-031880
- Practice address
- 12301 Snow Road
Parma, OH 44130 - Phone
- (216) 524-7377
- Fax
- (216) 479-5554
- NPI assigned
- Sep 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 35-031880 | OH | Primary |
Addresses
Primary practice location
12301 Snow Road
Parma, OH 44130
Mailing address
1001 Lakeside Ave E
#1200
Cleveland, OH 44114-1158
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0208895 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35-031880 | OH | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Radiology Corporation | Diagnostic Radiology | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Diagnostic Radiology Physician
- Fairlawn, OH
- NPI 1194869453
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1381276800000",
"number": "1801996277",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 LAKESIDE AVE E",
"address_2": "#1200",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441141158"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12301 SNOW ROAD",
"city": "PARMA",
"state": "OH",
"postal_code": "44130",
"telephone_number": "216-524-7377",
"fax_number": "216-479-5554"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RADEBAUGH",
"first_name": "DAVID",
"middle_name": "ELLIS",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-25",
"last_updated": "2013-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "OH",
"license": "35-031880",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0208895",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Parma, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.