NPIMap

Organization Active NPI

University Hospitals Conneaut Medical Center

  • Nurse Practitioner
  • Conneaut, OH
National Provider Identifier
1831545177
Registry record updated Apr 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
UNIVERSITY HOSPITALS CONNEAUT MEDICAL CENTER
Practice address
158 W Main Rd
Conneaut, OH 44030-2039
Phone
(440) 593-1131
NPI assigned
May 5, 2016
Last updated
Apr 29, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
UNIVERSITY HOSPITALS CONNEAUT MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 29, 2024

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

Authorized official

Name
Anthony Schillero
Title
Director, FP&a
Phone
(216) 767-8141

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary
Clinical Nurse SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 364S00000X

Addresses

Primary practice location

158 W Main Rd
Conneaut, OH 44030-2039

Mailing address

PO Box 772930
Detroit, MI 48277-2930
Phone (440) 593-1131

Other names 1

  • CONNEAUT HOUSE PROVIDERS Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://199.119.81.30:8291/Gateway/Documentsubmission/2_0/NhinService/XDRResponse_Service Other eSolutions Inc.

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161107001012 OH Part B Supplier - Clinic/Group Practice 0547429656 Receives reassigned benefits from 45 practitioners
1 other NPI on this enrollment
Practice locations: Conneaut, OH

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
Brown Memorial Hospital

Practitioners & affiliated clinicians

Practitioners 45

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1462406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714348800000",
    "number": "1831545177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 772930",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482772930",
            "telephone_number": "440-593-1131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 W MAIN RD",
            "city": "CONNEAUT",
            "state": "OH",
            "postal_code": "440302039",
            "telephone_number": "440-593-1131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY HOSPITALS CONNEAUT MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UNIVERSITY HOSPITALS CONNEAUT MEDICAL CENTER",
        "enumeration_date": "2016-05-05",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A",
        "authorized_official_last_name": "SCHILLERO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "DIRECTOR, FP&A",
        "authorized_official_telephone_number": "216-767-8141"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "364S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/Documentsubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "CONNEAUT HOUSE PROVIDERS",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "CONNEAUT HOUSE PROVIDERS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Conneaut, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2024; 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.