NPIMap

Organization Active NPI

Outreach Professional Services, Inc.

Doing business as Cuyahoga Physician Network

  • Surgery Physician
  • Willoughby, OH
National Provider Identifier
1932434289
Registry record updated Oct 5, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
OUTREACH PROFESSIONAL SERVICES, INC.
Doing business as
Cuyahoga Physician Network
Practice address
36060 Euclid Ave
Suite 107
Willoughby, OH 44094-4656
Phone
(440) 269-8346
Fax
(440) 975-5763
NPI assigned
Oct 5, 2009
Last updated
Oct 5, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2009

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

Authorized official

Name
Misty Blaylock
Title
Credentialing Coordinator
Phone
(440) 892-6406

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU Primary

Addresses

Primary practice location

36060 Euclid Ave
Suite 107
Willoughby, OH 44094-4656

Mailing address

26908 Detroit Rd
Suite 301
Westlake, OH 44145-2398
Phone (440) 617-1823

Other identifiers 1

IdentifierTypeStateIssuer
0251856MedicaidOH

Other names 1

  • Cuyahoga Physician Network Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Cuyahoga Physician Network22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1254700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254700800000",
    "number": "1932434289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26908 DETROIT RD",
            "address_2": "SUITE 301",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "441452398",
            "telephone_number": "440-617-1823",
            "fax_number": "440-617-0884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36060 EUCLID AVE",
            "address_2": "SUITE 107",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440944656",
            "telephone_number": "440-269-8346",
            "fax_number": "440-975-5763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTREACH PROFESSIONAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-05",
        "last_updated": "2009-10-05",
        "status": "A",
        "authorized_official_last_name": "BLAYLOCK",
        "authorized_official_first_name": "MISTY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "440-892-6406"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0251856",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cuyahoga Physician Network",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Willoughby, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2009; 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.