CLEVELAND BREAST CLINIC (NPI# 1215155015) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215155015 |
| Entity Type | Organization |
| Organization Name | CLEVELAND BREAST CLINIC |
| Practice Address |
18660 Bagley Rd Ste. 305 Bldg. 2 Cleveland OH 44130-3483 |
| Practice Telephone | 4402349338 |
| Practice Fax Number | 4402341448 |
| Mailing Telephone | 4402349338 |
| Mailing Fax Number | 4402341448 |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | AHMAD H. SHATILA (PHYSICIAN OWNER) |
| Authorized Official Telephone | 4402349338 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086X0206X |
Surgery Specialization: Surgical Oncology |
OH | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | UMWA | 1500454 | 01 |
| OH | BLUE CROSS | 000006129197 | 01 |
| Street Address |
18660 BAGLEY RD STE. 305 BLDG. 2 |
| City | CLEVELAND |
| State | OH |
| Zip Code | 44130-3483 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396746814 | Susan G Kasunick | Audiologist | 18660 Bagley Rd, Suite 404, Cleveland, OH 44130-3480 | 2005-08-09 |
| 1235554825 | Jennifer Mewhinney | Counselor | 18660 Bagley Rd, Medical Arts Building I, Suite 404, Cleveland, OH 44130-3483 | 2014-02-19 |
| 1851684427 | Katelyn M Shai | Counselor | 18660 Bagley Rd, Suite 204, Cleveland, OH 44130-3483 | 2011-05-16 |
| 1952599813 | Unni Pk Kumar Md Inc | Internal Medicine | 18660 Bagley Rd, Suite 501, Cleveland, OH 44130-3483 | 2007-10-04 |
| 1619160405 | Lisa A Boyd | Physical Therapist | 18660 Bagley Rd, Suite101, Cleveland, OH 44130-3483 | 2007-08-24 |
| 1639361710 | Katarina Stopko | Pediatrics | 18660 Bagley Rd, Ste 407, Cleveland, OH 44130-3483 | 2007-08-13 |
| 1114134194 | Joseph P Ferrini | Dentist | 18660 Bagley Rd, Bldg. I, Ste. 304, Cleveland, OH 44130-3483 | 2007-05-17 |
| 1225259500 | Jon P Kirlough | Dentist | 18660 Bagley Rd, Bldg. I, Ste. 304, Cleveland, OH 44130-3483 | 2007-05-02 |
| 1649491929 | Kirlough Family Dentistry, LLC | Dentist | 18660 Bagley Rd, Bldg I, Ste 304, Cleveland, OH 44130-3483 | 2007-05-02 |
| 1275655185 | Vincent J. Bertin, M.d., Inc | Surgery | 18660 Bagley Rd, Phase II, Suite 201, Cleveland, OH 44130-3483 | 2007-04-04 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912545427 | Northeast Care Center, Inc. | Intermediate Care Facility, Mentally Retarded | 19080 Bagley Road, Middleburg Hts., OH 44130 | 2019-12-16 |
| 1982189148 | Carl Steinhoff | Registered Nurse | 13766 Cherokee Trail, Middleburg Heights, OH 44130 | 2018-10-03 |
| 1649756321 | Beatrice Shepherd | Counselor | 5253 Hauserman Rd Apt 212, Parma, OH 44130 | 2018-07-16 |
| 1841705068 | New Heights Aba, LLC | Behavioral Analyst | 6908 Engle Rd Ste D, Middleburg Heights, OH 44130 | 2017-12-11 |
| 1275059842 | Tynisha Nicole Nation | Registered Nurse | 6431 Olde York, Parma Hts, OH 44130 | 2017-08-16 |
| 1609328558 | Lisa Wolanin | Physical Therapist | 186970bagley Road, Middleburg Hts, OH 44130 | 2016-10-26 |
| 1184074205 | Tanya Makowski | Nurse Practitioner | 7215 Old Oak Blvd Ste A420, Cleveland, OH 44130 | 2016-06-20 |
| 1093165706 | Dana Hyde | Dentist | 7528 Pearl Rd, Middleburg Heights, OH 44130 | 2016-06-14 |
| 1689046625 | Kimberly Ann Piro | Nurse Practitioner | 12240 Zona Ln, Parma, OH 44130 | 2015-10-29 |
| 1225400088 | Larrise Williford | Registered Nurse | 11491 Sharon Dr Apt C705, Parma, OH 44130 | 2015-10-20 |
| Find all providers in zip 44130 | ||||
| Taxonomy Code | 2086X0206X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Surgical Oncology |
| A surgical oncologist is a well-qualified surgeon who has obtained additional training and experience in the multidisciplinary approach to the prevention, diagnosis, treatment, and rehabilitation of cancer patients, and devotes a major portion of his or her professional practice to these activities and cancer research. |
| Notes: Source: Society of Surgical Oncology, 2007 [1/1/2008: definition added, source added, 7/1/2009: definiition reformatted] Additional Resources: http://www.surgonc.org/ ; American Board of Medical Specialties, 2007, www.abms.org ; American Board of Surgery, 2007, http://www.absurgery.org/ Surgical oncology is a recognized fellowship subspecialty program of surgery. Separate board certification is not currently offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356776454 | John Hart Raaf | Surgery | 12501 Fairhill Rd, Cleveland, OH 44120-1017 | 2013-09-08 |
| 1306491626 | Tasadooq Hussain | Surgery | Cleveland Clinic 9500 Euclid Avenue, Cleveland, OH 44195-0001 | 2019-08-04 |
| 1801113873 | Luke Daniel Rothermel | Surgery | 11100 Euclid Avenue, Cleveland, OH 44106-5047 | 2010-04-29 |
| 1902926751 | John Brian Ammori | Surgery | 11100 Euclid Ave, Cleveland, OH 44106-1716 | 2007-03-29 |
| 1689695355 | Natalie E Joseph | Surgery | 2500 Metrohealth Dr, Cleveland, OH 44109-1900 | 2006-07-21 |
| 1487672945 | Jill R Dietz | Surgery | 11100 Euclid Ave, Cleveland, OH 44106-1716 | 2006-07-17 |
| 1508894049 | Bruce J Averbook | Surgery | 2500 Metrohealth Dr, Mhmc-surgery/oncology, Cleveland, OH 44109-1900 | 2006-06-30 |
| 1154305753 | Diane M Radford | Surgery | 9500 Euclid Ave, A80, Cleveland, OH 44195-0001 | 2005-12-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184816290 | Rebecca L. Glaser | Surgery | 9530 Cutlers Trce, Dayton, OH 45458-9161 | 2007-08-13 |
| 1790975951 | Tri-state Surgical Consultants Inc | Surgery | 2123 Auburn Ave Ste 420, Cincinnati, OH 45219-2906 | 2007-07-25 |
| 1568562031 | Ahmad H. Shatila | Surgery | 18660 East Bagly Rd, Bldg #2 Suite #305, Middleburg Heights, OH 44130 | 2006-09-25 |
| 1962511998 | Bridget A. Oppong | Surgery | 1145 Olentangy River Rd Fl 3, Columbus, OH 43212-3117 | 2006-08-30 |
| 1932152162 | Edward Martin Jr. | Surgery | 300 W. 10th Avenue, Columbus, OH 43210 | 2006-05-18 |
| 1497715890 | Helen Catherine Mabry | Surgery | 3120 Glendale Avenue, Toledo, OH 43614-5811 | 2006-03-28 |
| 1184691230 | Jennifer Bryna Katz Manders | Surgery | 4440 Red Bank Road, Suite 200, Cincinnati, OH 45227-2172 | 2006-03-07 |
| 1548259492 | Brenda Jeanne Sickle-santanello | Surgery | 170 Northwoods Blvd Ste 210, Columbus, OH 43235-4711 | 2005-10-13 |
| 1982602363 | William Gress Kraybill Jr. | Surgery | 300 W 10th Ave, Columbus, OH 43210-1280 | 2005-07-11 |
| 1124580204 | Jessica Desalvo | Surgery | 5100 W Broad St, Columbus, OH 43228-1607 | 2019-04-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.