Eastside Primary Care LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

EASTSIDE PRIMARY CARE LLC

Practice address

36100 Euclid Ave
#430
Willoughby, OH 44094-4456

Phone

(440) 946-4070

Fax

(440) 946-4071

NPI assigned

Oct 27, 2010

Last updated

May 9, 2012By 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

Jean B Lenk, MDNPI 1770570335

Title

Owner

Phone

(440) 946-4070

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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.

• Jean B Lenk, M.D.

  • Internal Medicine Physician
  • Willoughby, OH
  • NPI 1770570335
  Authorized official Same address or phone

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

{
    "created_epoch": "1288137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336521600000",
    "number": "1922308774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22958",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441220958",
            "telephone_number": "216-595-9600",
            "fax_number": "216-595-9601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36100 EUCLID AVE",
            "address_2": "#430",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440944456",
            "telephone_number": "440-946-4070",
            "fax_number": "440-946-4071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-27",
        "last_updated": "2012-05-09",
        "status": "A",
        "authorized_official_last_name": "LENK",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "440-946-4070",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0819663",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hans Duiker
• Kelly S Dula, CRNA
• Tatiana Dwyer
• Orsolya Eads, CNP
• Shannon Easter Kelley, LISW
• Jennifer Edwards, R.PH.
• Stephanie Edwards, LPCC
• Maryellen L Eickman-Fiala, LD
• Eileen M Carney DDS Inc
• Elements Counseling LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2012; 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.