NPIMap

Organization Active NPI

Northeast Ohio Neighborhood Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Cleveland, OH
National Provider Identifier
1891287439
Registry record updated Dec 30, 2019
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.
Practice address
10505 Saint Clair Ave Ste 101
Cleveland, OH 44108-1973
Phone
(216) 325-6556
NPI assigned
May 30, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2019

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

10505 Saint Clair Ave Ste 101
Cleveland, OH 44108-1973

Mailing address

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190312002731 OH Part A Provider - Federally Qualified Health Center (FQHC) 5799756615 Practice locations: Cleveland, OH

Federally qualified health center certification: CCN 721812

Legal name
NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.
Doing business as
ST. CLAIR HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 12, 2019
Last certification
Mar 12, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 24, 1967 in OH
Enrollment address
10505 Saint Clair Ave
Ste 101
Cleveland, OH 44108-1973

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 Neighbor14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

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 DirectorMember Board of Trustees 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 and Chief Executive Offic 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 OfficerChief Medical Officer 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 2

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": "1527638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577664000000",
    "number": "1891287439",
    "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": "10505 SAINT CLAIR AVE STE 101",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441081973",
            "telephone_number": "216-325-6556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-30",
        "last_updated": "2019-12-30",
        "certification_date": "2019-12-30",
        "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",
        "authorized_official_name_suffix": "Sr."
    },
    "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 Cleveland, OH

Sources for this page

Verify at the official NPI Registry.