NPIMap

Organization Active NPI

Jamal Azem, M.D., Inc

  • Specialist
  • Willoughby, OH
National Provider Identifier
1992835656
Registry record updated Apr 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
35059071A Issued in OH
Legal business name
JAMAL AZEM, M.D., INC
Practice address
36100 Euclid Ave
Suite 330a
Willoughby, OH 44094-4456
Phone
(440) 269-8020
Fax
(440) 269-1646
NPI assigned
Mar 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2011

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

Authorized official

Name
Dr. Jamal AzemNPI 1518061811
Title
President
Phone
(440) 269-8020

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
SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174400000X 35059071A OH Primary

Addresses

Primary practice location

36100 Euclid Ave
Suite 330a
Willoughby, OH 44094-4456

Mailing address

36100 Euclid Ave
Suite 330a
Willoughby, OH 44094-4456
Phone (440) 269-8020

Other identifiers 1

IdentifierTypeStateIssuer
2928167MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060110000495 OH Part B Supplier - Clinic/Group Practice 1153344742 Receives reassigned benefits from 6 practitioners
Practice locations: Painesville, OH; Beachwood, OH; Willoughby, OH; Wickliffe, OH; Shaker Heights, OH; Northfield, OH; Bedford, OH; Mentor, OH…

National Provider Directory

National Provider Directory

Locations

7580 Auburn Rd
Ste 212
Concord Township, OH 44077

1963 Hubbard Rd
Madison, OH 44057
Phone (440) 428-6877

8881 Schaeffer St
Mentor, OH 44060
Phone (440) 255-9309

8840 Tyler Blvd
Mentor, OH 44060
Phone (440) 974-3459

9500 Mentor Ave
Ste 300
Mentor, OH 44060
Phone (440) 269-8020

1233 Mentor Ave
Painesville, OH 44077
Phone (440) 357-9262

18720 Chagrin Blvd
Shaker Heights, OH 44122
Phone (216) 295-7003

36100 Euclid Ave
Ste 330A
Willoughby, OH 44094
Phone (440) 269-8020

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302220800000",
    "number": "1992835656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36100 EUCLID AVE",
            "address_2": "SUITE 330A",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440944456",
            "telephone_number": "440-269-8020",
            "fax_number": "440-269-1646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36100 EUCLID AVE",
            "address_2": "SUITE 330A",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440944456",
            "telephone_number": "440-269-8020",
            "fax_number": "440-269-1646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAMAL AZEM, M.D., INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2011-04-08",
        "status": "A",
        "authorized_official_last_name": "AZEM",
        "authorized_official_first_name": "JAMAL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "440-269-8020",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "OH",
            "license": "35059071A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2928167",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Apr 8, 2011; 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.