NPIMap

Individual provider Active NPI

Thomas J. Mraz, PH.D.

  • Psychologist
  • Fairview Park, OH
National Provider Identifier
1821019357
Registry record updated Aug 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
7441 Issued in OH
Practice address
20800 Westgate Mall
Suite 103
Fairview Park, OH 44126-1323
Phone
(831) 901-7790
NPI assigned
Jul 21, 2006
Last updated
Aug 9, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 7441 OH Primary

Addresses

Primary practice location

20800 Westgate Mall
Suite 103
Fairview Park, OH 44126-1323

Mailing address

PO Box 45075
Westlake, OH 44145-0075
Phone (831) 917-7900

Other identifiers 6

IdentifierTypeStateIssuer
FHC 70044FOtherCAMEDI-CAL GROUP PROVIDER#
FHC 70042FOtherCAMEDI-CAL GROUP PROVIDER#
ZZZ91891ZOtherCASANTA CRUZ COUNTY MEDICARE GROUP PTAN#
ZZZ91892ZOtherCASANTA CRUZ COUNTY MEDICARE GROUP PTAN#
ZZZ92069ZOtherCASANTA CRUZ COUNTY MEDICARE GROUP PTAN#
PSY 20869OtherCAPSYCHOLOGIST LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161024000615 OH Practitioner - Clinical Psychologist 5890884456 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1990
Medicare assignment
May accept Medicare assignment
Group practices
Integrative Psychological Health LLCGroup PAC ID 6608174685, 3 clinicians

Practice addresses (Care Compare)

26777 Lorain Rd
Suite 412
North Olmsted, OH 44070-3224
Phone (216) 801-4656

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
20869CAMDAddiction (Substance Use Disorder) Counselor
7441OHMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
MHSP,Inc Past Accepting new patients
County of Santa Cruz Past Accepting new patients
County of Santa Cruz Past Accepting new patients
County of Santa Cruz Past Accepting new patients
County of Santa Cruz Past Accepting new patients
Puentes Al Sur Past Accepting new patients

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470700800000",
    "number": "1821019357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 45075",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "441450075",
            "telephone_number": "831-917-7900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20800 WESTGATE MALL",
            "address_2": "SUITE 103",
            "city": "FAIRVIEW PARK",
            "state": "OH",
            "postal_code": "441261323",
            "telephone_number": "831-901-7790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MRAZ",
        "first_name": "THOMAS",
        "middle_name": "J.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2016-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OH",
            "license": "7441",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL GROUP PROVIDER#",
            "identifier": "FHC 70044F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL GROUP PROVIDER#",
            "identifier": "FHC 70042F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SANTA CRUZ COUNTY MEDICARE GROUP PTAN#",
            "identifier": "ZZZ91891Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SANTA CRUZ COUNTY MEDICARE GROUP PTAN#",
            "identifier": "ZZZ91892Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SANTA CRUZ COUNTY MEDICARE GROUP PTAN#",
            "identifier": "ZZZ92069Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHOLOGIST LICENSE",
            "identifier": "PSY 20869",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairview Park, OH

Sources for this page

Verify at the official NPI Registry.