NPIMap

Organization Active NPI

Northeast Ohio Neighborhood Health Services, Inc.

Doing business as NEON Panther Wellness Center-Euclid SBHC

  • Federally Qualified Health Center (FQHC)
  • Euclid, OH
National Provider Identifier
1881319283
Registry record updated Oct 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.
Doing business as
NEON Panther Wellness Center-Euclid SBHC
Practice address
711 E 222ND St
Euclid, OH 44123-2033
Phone
(216) 797-7800
NPI assigned
Oct 7, 2022
Last updated
Oct 7, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2022

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

Authorized official

Name
Willie F. Austin
Title
President & Ceo
Phone
(216) 231-7700

Specialties & licenses 1

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

Addresses

Primary practice location

711 E 222ND St
Euclid, OH 44123-2033

Mailing address

4800 Payne Ave
Cleveland, OH 44103-2443
Phone (216) 231-7700

Other names 1

  • NEON Panther Wellness Center-Euclid SBHC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230616001061 OH Part A Provider - Federally Qualified Health Center (FQHC) 5799756615 Practice locations: Euclid, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881319283. Details of each certification follow.

Federally qualified health center certification: CCN D21000

Legal name
NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.
Doing business as
PANTHER WELLNESS CENTER-EUCLID SBHC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 11, 2023
Last certification
May 11, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 24, 1967 in OH
Enrollment address
711 E 222ND St
Euclid, OH 44123-2033

Other NPIs with the same Medicare PAC ID 12

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

National Provider Directory

National Provider Directory
Tax ID family
Northeast Ohio Neigh HL15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Locations

15201 Euclid Ave
East Cleveland, OH 44112
Phone (216) 541-5600

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Tenisha Gant-Watson Individual Corporate DirectorBoard of Trustees Member Jan 1, 2015
Liang Chen Individual Corporate OfficerChief Financial Officer Jan 1, 2019
Karen Butler Individual Corporate OfficerChief Operating Officer Apr 1, 2014
Willie F Austin Individual Corporate OfficerPresident & Chief Executive Officer Mar 1, 2003
W-2 Managing EmployeePresident & Chief Executive Officer Mar 1, 2003
Phyllis Weeden-Oliver Individual Corporate DirectorMember Board of Trustees Jan 1, 2012
Stacie Spears Individual Corporate DirectorMember Board of Trustees Jan 1, 2012
Anita M Watson Individual Corporate OfficerMedical Director Jan 1, 2013
Audra Ameen Individual Corporate DirectorMember Board of Trustees Jan 1, 2007
Edward McGhee Individual Corporate DirectorMember Board of Trustees Mar 10, 2021

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 3

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": "1665100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665100800000",
    "number": "1881319283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 PAYNE AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441032443",
            "telephone_number": "216-231-7700",
            "fax_number": "216-231-3828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 E 222ND ST",
            "city": "EUCLID",
            "state": "OH",
            "postal_code": "441232033",
            "telephone_number": "216-797-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-07",
        "last_updated": "2022-10-07",
        "certification_date": "2022-10-07",
        "status": "A",
        "authorized_official_last_name": "AUSTIN",
        "authorized_official_first_name": "WILLIE",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "216-231-7700"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NEON Panther Wellness Center-Euclid SBHC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Euclid, OH

Sources for this page

Verify at the official NPI Registry.