NPIMap

Organization Active NPI

Comprehensive Surgical Group of Northeast Ohio LTD

  • Surgery Physician
  • Boardman, OH
National Provider Identifier
1831506369
Registry record updated Jul 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
COMPREHENSIVE SURGICAL GROUP OF NORTHEAST OHIO LTD
Practice address
7645 Market St
200
Boardman, OH 44512-5980
Phone
(330) 707-0771
Fax
(330) 707-0618
NPI assigned
Jul 16, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2014

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

Authorized official

Name
Stephen Evan, MDNPI 1639141187
Title
Physician
Phone
(330) 707-0771

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

7645 Market St
200
Boardman, OH 44512-5980

Mailing address

7645 Market St.
Ste# 200
Boardman, OH 44512-5980
Phone (330) 707-0771

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150205001998 OH Part B Supplier - Clinic/Group Practice 0941525349 Receives reassigned benefits from 4 practitioners
Practice locations: Boardman, OH

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1405468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405468800000",
    "number": "1831506369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7645 MARKET ST.",
            "address_2": "STE# 200",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445125980",
            "telephone_number": "330-707-0771",
            "fax_number": "330-707-0618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7645 MARKET ST",
            "address_2": "200",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445125980",
            "telephone_number": "330-707-0771",
            "fax_number": "330-707-0618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPREHENSIVE SURGICAL GROUP OF NORTHEAST OHIO LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-16",
        "last_updated": "2014-07-16",
        "status": "A",
        "authorized_official_last_name": "EVAN",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "330-707-0771",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boardman, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.