PPH Ohio LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

PPH OHIO LLC

Doing business as

Passport Health

Practice address

21825 Chagrin Boulevard
Suite 345
Beachwood, OH 44122-5337

Phone

(877) 358-8648

Fax

(877) 877-6875

NPI assigned

Mar 19, 2014

Last updated

Apr 1, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Paul Fishburn

Title

Chief Operating Officer

Phone

(480) 646-9020

Specialties & licenses 1

Addresses

Other names 1

• Passport Health Doing business as

Tax ID family

Passport Health5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

• Passport Health

  • Clinic/Center
  • Greensboro, NC
  • NPI 1497449292
  NPD tax ID
• Passport Health

  • Clinic/Center
  • Winston Salem, NC
  • NPI 1588358477
  NPD tax ID
• Passport Health

  • Clinic/Center
  • San Antonio, TX
  • NPI 1841984655
  NPD tax ID
• Passport Health Ohio LLC

  dba Passport Health

  • Clinic/Center
  • Greenville, SC
  • NPI 1396175287
  NPD tax ID

Locations

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

{
    "created_epoch": "1395187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648771200000",
    "number": "1821415548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "668 N 44TH ST",
            "address_2": "SUITE 100W",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850086507",
            "telephone_number": "877-358-8648",
            "fax_number": "877-877-6875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21825 CHAGRIN BOULEVARD",
            "address_2": "SUITE 345",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441225337",
            "telephone_number": "877-358-8648",
            "fax_number": "877-877-6875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PPH OHIO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-19",
        "last_updated": "2022-04-01",
        "certification_date": "2022-04-01",
        "status": "A",
        "authorized_official_last_name": "FISHBURN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "480-646-9020",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Passport Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Passport Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Thomas Ryan Powers, PT
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• Praveena Prasai Berlin, APRN.CNP
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• Premier Mental Health, LLC

• Clinic/Center in Beachwood, OH
• Providers in Beachwood, OH by specialty
• Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.