NPIMap

Organization Active NPI

Mount Vernon Developmental Center

  • Intellectual Disabilities Intermediate Care Facility
  • Mount Vernon, OH
National Provider Identifier
1992869069
Registry record updated Aug 24, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
MOUNT VERNON DEVELOPMENTAL CENTER
Practice address
1250 Vernonview Dr
Mount Vernon, OH 43050-1447
Phone
(740) 393-6231
Fax
(740) 393-6266
NPI assigned
Dec 21, 2006
Last updated
Aug 24, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
STATE OF OHIOAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 24, 2010

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

Authorized official

Name
Mr. Ernst Fischer
Title
Superintendent
Phone
(740) 393-6231

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X OH Primary

Addresses

Primary practice location

1250 Vernonview Dr
Mount Vernon, OH 43050-1447

Mailing address

1250 Vernonview Dr
Mount Vernon, OH 43050-1447
Phone (740) 393-6231

Other identifiers 1

IdentifierTypeStateIssuer
2411732MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031202000209 OH Part B Supplier - Clinic/Group Practice 0143133181 Receives reassigned benefits from 261 practitioners
28 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Northfield, OH; Youngstown, OH; Toledo, OH; Tiffin, OH; Mt Vernon, OH; Mineral Ridge, OH; Massillon, OH; Huber Heights, OH…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992869069. Details of each certification follow.

  • CCN 36G592 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 36G592

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MT VERNON DEVELOPMENTAL CENTER
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jul 18, 2003
Last certification
Apr 13, 2023
Beds
78
Ownership / control type
State
Facility address
1250 Vernonview Drive
Mount Vernon, OH 43050

Other NPIs on the same Medicare enrollment 26

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

View all 26

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D0655738Mount Vernon Developmental Center1250 Vernonview Drive, Mount Vernon, OH 43050Certificate of waiverNov 18, 2027

National Provider Directory

National Provider Directory
Tax ID family
Central Ohio Pyschiatri39 organizations share this tax ID, including this one
Part of
Central Ohio Pyschiatri

Other organizations with this tax ID 38

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

View all 38

Locations

1810 Sullivant Ave
Columbus, OH 43222
Phone (614) 641-4055

1250 Vernonview Dr
Mount Vernon, OH 43050
Phone (740) 393-6200

Practitioners & affiliated clinicians

Practitioners 3

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": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282608000000",
    "number": "1992869069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 VERNONVIEW DR",
            "city": "MOUNT VERNON",
            "state": "OH",
            "postal_code": "430501447",
            "telephone_number": "740-393-6231",
            "fax_number": "740-393-6266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 VERNONVIEW DR",
            "city": "MOUNT VERNON",
            "state": "OH",
            "postal_code": "430501447",
            "telephone_number": "740-393-6231",
            "fax_number": "740-393-6266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT VERNON DEVELOPMENTAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF OHIO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2010-08-24",
        "status": "A",
        "authorized_official_last_name": "FISCHER",
        "authorized_official_first_name": "ERNST",
        "authorized_official_title_or_position": "SUPERINTENDENT",
        "authorized_official_telephone_number": "740-393-6231",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2411732",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, OH

Sources for this page

Verify at the official NPI Registry.