NPIMap

Organization Active NPI

Marymount Primary Care Services, Inc.

  • Family Medicine Physician
  • Independence, OH
National Provider Identifier
1902097751
Registry record updated May 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MARYMOUNT PRIMARY CARE SERVICES, INC.
Practice address
6701 Rockside Rd
Suite 260
Independence, OH 44131-2358
Phone
(216) 369-2525
Fax
(216) 369-2531
NPI assigned
Aug 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2008

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

Authorized official

Name
Peter P Walchanowicz
Title
Practice Manager
Phone
(440) 543-8855

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X

Addresses

Primary practice location

6701 Rockside Rd
Suite 260
Independence, OH 44131-2358

Mailing address

6701 Rockside Rd
Suite 260
Independence, OH 44131-2358
Phone (216) 369-2525

Other identifiers 2

IdentifierTypeStateIssuer
000000564009OtherOHANTHEM
2686106MedicaidOH

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1186444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211932800000",
    "number": "1902097751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6701 ROCKSIDE RD",
            "address_2": "SUITE 260",
            "city": "INDEPENDENCE",
            "state": "OH",
            "postal_code": "441312358",
            "telephone_number": "216-369-2525",
            "fax_number": "216-369-2531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6701 ROCKSIDE RD",
            "address_2": "SUITE 260",
            "city": "INDEPENDENCE",
            "state": "OH",
            "postal_code": "441312358",
            "telephone_number": "216-369-2525",
            "fax_number": "216-369-2531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYMOUNT PRIMARY CARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-07",
        "last_updated": "2008-05-28",
        "status": "A",
        "authorized_official_last_name": "WALCHANOWICZ",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "440-543-8855"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000564009",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2686106",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Independence, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.