Active NPI
Ellis Martinez Graham Jr.
- Peer Specialist
- North Olmsted, OH
National Provider Identifier
1962025486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- Practice address
- 24695 Maple Ridge Rd
North Olmsted, OH 44070-1274 - Phone
- (216) 278-5702
- NPI assigned
- May 19, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | Primary |
Addresses
Primary practice location
24695 Maple Ridge Rd
North Olmsted, OH 44070-1274
Mailing address
24695 Maple Ridge Rd
North Olmsted, OH 44070-1274
Phone (216) 278-5702
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1589846400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589846400000",
"number": "1962025486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24695 MAPLE RIDGE RD",
"city": "NORTH OLMSTED",
"state": "OH",
"postal_code": "440701274",
"telephone_number": "216-278-5702"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24695 MAPLE RIDGE RD",
"city": "NORTH OLMSTED",
"state": "OH",
"postal_code": "440701274",
"telephone_number": "216-278-5702"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "ELLIS",
"middle_name": "MARTINEZ",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-05-19",
"last_updated": "2020-05-19",
"certification_date": "2020-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Olmsted, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.