GEAUGA SPORTS MEDICINE, LLC (NPI# 1396746970) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396746970 |
| Entity Type | Organization |
| Organization Name | GEAUGA SPORTS MEDICINE, LLC |
| Practice Address |
13207 Ravenna Rd Chardon OH 44024-7032 |
| Mailing Address |
Po Box 567 Chagrin Falls OH 44022-0567 |
| Practice Telephone | 4402856452 |
| Practice Fax Number | 4402851796 |
| Mailing Telephone | 2164645160 |
| Mailing Fax Number | 2164645982 |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2008-10-01 |
| Authorized Official Name | MICHAEL J KELIS (PRESIDENT) |
| Authorized Official Telephone | 4402856452 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2083S0010X |
Preventive Medicine Specialization: Sports Medicine |
========= | OH | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | RR MEDICARE | 250006704 | 01 |
| Street Address |
13207 RAVENNA RD |
| City | CHARDON |
| State | OH |
| Zip Code | 44024-7032 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982608394 | Rachael Maxine Lerman | Pharmacist | 13207 Ravenna Rd, Pharmacy Services, Chardon, OH 44024-7032 | 2005-06-13 |
| 1427656420 | Sarah Nicole Blair | Internal Medicine | 13207 Ravenna Rd, Chardon, OH 44024-7032 | 2020-10-12 |
| 1699386565 | Taylor Baum | Pharmacist | 13207 Ravenna Rd, Chardon, OH 44024-7032 | 2020-08-13 |
| 1578173225 | Jessica Uhl | Pharmacy | 13207 Ravenna Rd, Chardon, OH 44024-7032 | 2020-08-07 |
| 1568008159 | Sarah Knowles | Clinical Nurse Specialist | 13207 Ravenna Rd, Chardon, OH 44024-7032 | 2019-11-19 |
| 1457996043 | Laurie Catherine Bruening | Nurse Practitioner | 13207 Ravenna Rd, Chardon, OH 44024-7032 | 2019-11-07 |
| 1881247898 | Nicole Guist | Pharmacist | 13207 Ravenna Rd, Chardon, OH 44024-7032 | 2019-07-18 |
| 1295395648 | Krzysztof Ozga | Pharmacist | 13207 Ravenna Rd, Chardon, OH 44024-7032 | 2019-06-18 |
| 1346704285 | Chad William Crouch | Nurse Anesthetist, Certified Registered | 13207 Ravenna Rd, Chardon, OH 44024-7032 | 2019-01-24 |
| 1295207769 | Joshua Mark Fegan | Nurse Anesthetist, Certified Registered | 13207 Ravenna Rd, Chardon, OH 44024-7032 | 2018-12-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992336770 | Amanda Nicole Nelson | Technician, Other | 133 Up Main St, Chardon, OH 44024 | 2020-01-30 |
| 1679067011 | Janai Marshae Seng | Dentist | 401 South Street #3a, Chardon, OH 44024 | 2018-06-19 |
| 1376036475 | Kasandra Leigh Chapman | Social Worker | 12941 Ravenna Road, Chardon, OH 44024 | 2018-06-13 |
| 1275068652 | Danielle Tilton | Nurse Practitioner | 531 Fifth Ave, Chardon, OH 44024 | 2017-04-24 |
| 1881057040 | Erin Marie Moore | Counselor | 203 Main St., Chardon, OH 44024 | 2016-04-04 |
| 1649689886 | Hope Anne Super | Speech-Language Pathologist | 100 7th Av Suite 255, Chardon, OH 44024 | 2014-08-12 |
| 1740600022 | Elisha Tzvi Fredman | Student in an Organized Health Care Education/Training Program | 13207 Chardon Road, Ravenna, OH 44024 | 2014-04-24 |
| 1083039309 | Jamie Delvecchio | Family Medicine | 150 7th Ave Ste 200, Chardon, OH 44024 | 2014-02-24 |
| 1174947212 | Frank Scarano | Psychologist | 470 Center Street, Chardon, OH 44024 | 2014-02-10 |
| 1659706497 | Jamie Henderson | Physical Therapy Assistant | 9348 South Brown Rd, Chardon, OH 44024 | 2013-09-12 |
| Find all providers in zip 44024 | ||||
| Taxonomy Code | 2083S0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Preventive Medicine |
| Specialization | Sports Medicine |
| A preventive medicine physician who specializes in the diagnosis and treatment of sports related conditions and injuries. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Preventive Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194333641 | Christopher Jacob Devlin | Preventive Medicine | 8332 Seattle Ave Apt 10112, Columbus, OH 43240-1564 | 2020-07-21 |
| 1205851185 | Deborah Dalsin | Preventive Medicine | 366 Richland Ave, Apt 2306, Athens, OH 45701-3211 | 2006-07-13 |
| 1649236944 | Kristen Noelle Phillips | Preventive Medicine | 2484 W State St, Alliance, OH 44601-5608 | 2006-04-25 |
| 1952710295 | Kim Barry | Preventive Medicine | 200 Woodland St, Oberlin, OH 44074-1051 | 2014-08-12 |
| 1922331230 | Courtney Nolan | Preventive Medicine | 33100 Cleveland Clinic Blvd, Avon, OH 44011-1390 | 2009-09-18 |
| 1184622912 | Mary Jo Logee | Preventive Medicine | 3373 Commerce Pkwy, Suite 2, Wooster, OH 44691-7130 | 2005-07-14 |
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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.