NPIMap

Organization Active NPI

City of Cincinnati

  • Primary Care Clinic/Center
  • Cincinnati, OH
National Provider Identifier
1831102151
Registry record updated Jan 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
CITY OF CINCINNATI
Practice address
3101 Burnet Avenue
Ambrose H Clement Health Center
Cincinnati, OH 45229-3014
Phone
(513) 357-7300
Fax
(513) 357-7307
NPI assigned
Aug 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2012

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

Authorized official

Name
Mr. Noble Maseru, PHD MPH
Title
Health Commissioner
Phone
(513) 357-7280

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X
Primary Care Clinic/Center 261QP2300X Primary
Clinical Medical Laboratory 291U00000X 36D0894909 OH

Addresses

Primary practice location

3101 Burnet Avenue
Ambrose H Clement Health Center
Cincinnati, OH 45229-3014

Mailing address

3101 Burnet Avenue
Cincinnati, OH 45229-3014
Phone (513) 357-7289

Other identifiers 1

IdentifierTypeStateIssuer
0184652MedicaidOH

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031118001094 OH Part B Supplier - Clinic/Group Practice 3476467804 Receives reassigned benefits from 49 practitioners
11 other NPIs on this enrollment
Practice locations: Cincinnati, OH
O20090922000653 OH Part A Provider - Federally Qualified Health Center (FQHC) 3476467804 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cincinnati, OH

Federally qualified health center certification: CCN 361957

Legal name
CITY OF CINCINNATI
Doing business as
AMBROSE H. CLEMENT HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 29, 2009
Last certification
Oct 29, 2009
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Enrollment address
3101 Burnet Ave
Cincinnati, OH 45229-3014

Other NPIs on the same Medicare enrollment 12

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

National Provider Directory

National Provider Directory

Locations

3101 Burnet Ave
#H
Cincinnati, OH 45229
Phone (513) 357-7300

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Grant Mussman Individual Corporate Director Mar 5, 2019
W-2 Managing Employee Mar 5, 2019
Operational/Managerial Control Mar 5, 2019
City of Cincinnati Organization, Cincinnati, OH 5% Or Greater Direct Ownership Interest Jan 1, 1980 100%
Robert Schlanz Individual W-2 Managing EmployeeCfo Oct 29, 2009 100%
Operational/Managerial ControlCfo Oct 29, 2009 100%
Braden McMahon Individual W-2 Managing EmployeeBilling Manager Mar 8, 2008
Noble Maseru Individual Corporate DirectorHealth Commissioner Jul 15, 2009 100%
W-2 Managing EmployeeHealth Commissioner Jul 15, 2009 100%
Operational/Managerial ControlHealth Commissioner Jul 15, 2009 100%

All facility ownership & control disclosures 20

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
City of Cincinnati-Braxton Cann Memorial Medical CenterCincinnati, OH, CCN 361954 Federally qualified health center Operational/Managerial Control Jul 15, 2009
City of Cincinnati Primary Care-Millvale @Hopple Health CenterCincinnati, OH, CCN 361955 Federally qualified health center Operational/Managerial Control Jul 15, 2009
Northside Health CenterCincinnati, OH, CCN 361956 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1970
Ambrose H. Clement Health CenterCincinnati, OH, CCN 361957 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1980
Crest Smile ShoppeCincinnati, OH, CCN 361958 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1980
City of CincinnatiCincinnati, OH, CCN 361803 Federally qualified health center Operational/Managerial Control Jul 15, 2010
Price Hill Health CenterCincinnati, OH, CCN 361816 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 16, 1976
Cincinnati Health Department - John P. Parker SBHCCincinnati, OH, CCN 361068 Federally qualified health center Operational/Managerial Control Jan 12, 2006
Cincinnati Health Department - Riverview East SBHCCincinnati, OH, CCN 361066 Federally qualified health center Operational/Managerial Control (100%) Jan 12, 2006
Cincinnati Health Department - Mt Airy SBHCCincinnati, OH, CCN 361067 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 12, 2006
Cincinnati Health Department - the Children'S Home of CincinnatiCincinnati, OH, CCN 361110 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 1, 2016
Jan 12, 2006
Cincinnati Health Department - Taft High SchoolCincinnati, OH, CCN 361111 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 12, 2006
Jan 12, 2006
Roll Hill AcademyCincinnati, OH, CCN 361145 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2017
Oyler Community Learning CenterCincinnati, OH, CCN 361146 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2017
City of CincinnatiCincinnati, OH, CCN 361151 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2017
Roberts PaideiaCincinnati, OH, CCN 361153 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2017
Ethel M Taylor AcademyCincinnati, OH, CCN 361152 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2017
Cincinnati Health Department - Deaconess Health Check at Western HillsCincinnati, OH, CCN 361167 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 1, 2012
Jan 12, 2006
Cincinnati Health Department - Withrow High SchoolCincinnati, OH, CCN 361168 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 12, 2006
Jan 12, 2006
Cincinnati Health Department - Academy of World Languages SBHCCincinnati, OH, CCN 361169 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 12, 2006
Jan 12, 2006

Practitioners & affiliated clinicians

Practitioners 49

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

View all 49

NPI Registry JSON

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326931200000",
    "number": "1831102151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3101 BURNET AVENUE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452293014",
            "telephone_number": "513-357-7289",
            "fax_number": "513-357-7396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 BURNET AVENUE",
            "address_2": "AMBROSE H CLEMENT HEALTH CENTER",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452293014",
            "telephone_number": "513-357-7300",
            "fax_number": "513-357-7307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF CINCINNATI",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-15",
        "last_updated": "2012-01-19",
        "status": "A",
        "authorized_official_last_name": "MASERU",
        "authorized_official_first_name": "NOBLE",
        "authorized_official_title_or_position": "HEALTH COMMISSIONER",
        "authorized_official_telephone_number": "513-357-7280",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHD MPH"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "OH",
            "license": "36D0894909",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0184652",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

Verify at the official NPI Registry.