Erieside Medical Group

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35-052285D Issued in OH

Legal business name

ERIESIDE MEDICAL GROUP

Practice address

38429 Lake Shore Blvd
Willoughby, OH 44094-7009

Phone

(440) 946-9200

NPI assigned

Apr 21, 2006

Last updated

Jun 10, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Winston Ho, M.D.NPI 1194802454

Title

President

Phone

(440) 269-7483

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DAHEBA

Practitioners 2

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.

• Winston Ho, MD

  • Internal Medicine Physician
  • Willoughby, OH
  • NPI 1194802454
  Medicare reassignment NPD Authorized official
• Iryna Hornback, APRN-FPA, FNP-C

  • Family Nurse Practitioner
  • Mokena, IL
  • NPI 1508139023

  OH

  Medicare reassignment NPD

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276128000000",
    "number": "1891751657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38429 LAKE SHORE BLVD",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440947009",
            "telephone_number": "440-946-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38429 LAKE SHORE BLVD",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440947009",
            "telephone_number": "440-946-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERIESIDE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-21",
        "last_updated": "2010-06-10",
        "status": "A",
        "authorized_official_last_name": "HO",
        "authorized_official_first_name": "WINSTON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "440-269-7483",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35-052285D",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35-06-5285H",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "34-003413F",
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NU",
            "license": "35-06-1390M",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Willoughby, OH
• Providers in Willoughby, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2010; 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.