Organization Active NPI

Family Success Consortium Inc

  • Psychologist
  • Cincinnati, OH
National Provider Identifier
1942520648
Registry record updated Jun 24, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
4512 Issued in OH
Legal business name
FAMILY SUCCESS CONSORTIUM INC
Practice address
2650 Madison Rd
Cincinnati, OH 45208-1332
Phone
(513) 772-9300
Fax
(513) 772-9302
NPI assigned
Jun 3, 2010
Last updated
Jun 24, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2010

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

Authorized official

Name
Dr. Mark Kendal Evans, PSY.D.NPI 1437373487
Title
Psychologist
Phone
(513) 772-9300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 4512 OH Primary

Addresses

Primary practice location

2650 Madison Rd
Cincinnati, OH 45208-1332

Mailing address

2650 Madison Rd
Cincinnati, OH 45208-1332
Phone (513) 772-9300

Other identifiers 1

IdentifierTypeStateIssuer
0903848MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120409000473 OH Part B Supplier - Clinic/Group Practice 3375585813 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
Practice locations: Cincinnati, OH

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

2650 Madison Rd
Cincinnati, OH 45208
Phone (513) 772-9300

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1275523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277337600000",
    "number": "1942520648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 MADISON RD",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452081332",
            "telephone_number": "513-772-9300",
            "fax_number": "513-772-9302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 MADISON RD",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452081332",
            "telephone_number": "513-772-9300",
            "fax_number": "513-772-9302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY SUCCESS CONSORTIUM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-03",
        "last_updated": "2010-06-24",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "KENDAL",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "513-772-9300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OH",
            "license": "4512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0903848",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.