NPIMap

Organization Active NPI

Signature Health Inc.

  • Federally Qualified Health Center (FQHC)
  • Garfield HTS, OH
National Provider Identifier
1871031922
Registry record updated Feb 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SIGNATURE HEALTH INC.
Practice address
5410 Transportation Blvd
Garfield HTS, OH 44125-5380
Phone
(216) 663-6100
NPI assigned
Feb 9, 2017
Last updated
Feb 9, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2017

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

Authorized official

Name
Ryan Wood
Title
Cfo
Phone
(440) 953-9999

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

5410 Transportation Blvd
Garfield HTS, OH 44125-5380

Mailing address

5410 Transportation Blvd
Garfield HTS, OH 44125-5380

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170426002084 OH Part A Provider - Federally Qualified Health Center (FQHC) 8628970985 Practice locations: Maple Heights, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871031922. Details of each certification follow.

Federally qualified health center certification: CCN 361132

Legal name
SIGNATURE HEALTH, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 15, 2017
Last certification
Apr 15, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 12, 1993 in OH
Enrollment address
21100 Southgate Park Blvd
Maple Heights, OH 44137-3004

Other NPIs with the same Medicare PAC ID 9

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D2116713Signature Health Inc - Maple Heights21100 Southgate Blvd, Suite4, Maple Heights, OH 44137Provider-performed microscopyJul 28, 2028

National Provider Directory

National Provider Directory
Tax ID family
The North Coast Center29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

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

View all 28

Locations

5410 Transportation Blvd
Garfield Hts, OH 44125
Phone (216) 663-6100

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Jonathan Lee Individual Corporate OfficerCeo Oct 13, 1993
W-2 Managing EmployeeCeo Oct 13, 1993 100%
Paul Fuller Individual Corporate Director Jul 1, 2016
Heather Brissett Individual Corporate Director Jan 1, 2017
Kelly Farrell Individual Corporate Director Jul 1, 2016
Giovanni Dilalla Individual Corporate Director Jan 1, 2017
Jennifer Sample Individual Corporate Director Apr 1, 2017
Michelle Ann Echevarria Individual Corporate Director May 1, 2022
Paula Anzlovar Individual Corporate Director Apr 1, 2017
Georgia Brickman Individual Corporate Director Jul 1, 2016
Gregory Walker Individual Corporate Director May 1, 2022
Charles Strawbridge Individual Corporate Director Jul 1, 2016
Stephanie Malbasa Individual Corporate Director Jan 1, 2016
Josephine Jones Individual Corporate Director Jul 1, 2016
Earl Tucker Individual Corporate Director Feb 2, 2021

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1486598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486598400000",
    "number": "1871031922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5410 TRANSPORTATION BLVD",
            "city": "GARFIELD HTS",
            "state": "OH",
            "postal_code": "441255380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5410 TRANSPORTATION BLVD",
            "city": "GARFIELD HTS",
            "state": "OH",
            "postal_code": "441255380",
            "telephone_number": "216-663-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIGNATURE HEALTH INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-09",
        "last_updated": "2017-02-09",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "440-953-9999"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Garfield HTS, OH

Sources for this page

Verify at the official NPI Registry.