NPIMap

Organization Active NPI

Ohio Permanente Medical Group

  • Internal Medicine Physician
  • North Canton, OH
National Provider Identifier
1942583646
Registry record updated Sep 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
OHIO PERMANENTE MEDICAL GROUP
Practice address
4914 Portage St NW
North Canton, OH 44720-7249
Phone
(216) 265-8844
Fax
(216) 265-8894
NPI assigned
Sep 20, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2011

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

Authorized official

Name
Mr. Craig Faerber
Title
VP/Cfo
Phone
(216) 265-8844

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X OH
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X OH Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X OH

Addresses

Primary practice location

4914 Portage St NW
North Canton, OH 44720-7249

Mailing address

12301 Snow Rd
Parma, OH 44130-1002
Phone (216) 265-8844

Other identifiers 1

IdentifierTypeStateIssuer
0211372MedicaidOH

Other names 1

  • Kaiser Permanente Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Kaiser Permanente16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1316476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316476800000",
    "number": "1942583646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12301 SNOW RD",
            "city": "PARMA",
            "state": "OH",
            "postal_code": "441301002",
            "telephone_number": "216-265-8844",
            "fax_number": "216-265-8894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4914 PORTAGE ST NW",
            "city": "NORTH CANTON",
            "state": "OH",
            "postal_code": "447207249",
            "telephone_number": "216-265-8844",
            "fax_number": "216-265-8894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OHIO PERMANENTE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-20",
        "last_updated": "2011-09-20",
        "status": "A",
        "authorized_official_last_name": "FAERBER",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "VP/CFO",
        "authorized_official_telephone_number": "216-265-8844",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "OH",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "OH",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0211372",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kaiser Permanente",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Canton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2011; 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.