NORTH EAST OHIO GROUP PRACTICE LLC – Internal Medicine Physician, NPI 1063575462
Internal Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for NORTH EAST OHIO GROUP PRACTICE LLC
29000 Center Ridge Rd
Westlake, OH 441455293
Phone: (440) 835-8000
Type: Location
2351 E 22nd St Fl 7
Cleveland, OH 441153111
Phone: (216) 592-2830
Type: Location
1730 W 25th St
Cleveland, OH 441133108
Phone: (216) 696-4300
Type: Location
630 E River St
Elyria, OH 440355902
Phone: (440) 329-7500
Type: Location
6990 Engle Rd
Middleburg Heights, OH 441303420
Phone: (440) 202-4200
Type: Location
4200 Interchange Corporate Center Rd
Warrensville Heights, OH 441285631
Phone: (216) 910-3800
Type: Location
7007 Powers Blvd
Parma, OH 441295437
Phone: (440) 743-4333
Type: Location
Bainbridge Road, Cleveland Heights, Cuyahoga County, Ohio, 44118, United States
CLEVELAND, OH 441392275
Phone: (440) 542-5000
Fax: (440) 542-5005
Type: Mailing
18697 Bagley Rd
Middleburg Heights, OH 441303417
Phone: (440) 542-5000
Fax: (440) 542-5005
Type: Location
11900 Fairhill Rd
Cleveland, OH 441201062
Phone: (216) 983-8030
Type: Location
18697 BAGLEY RD
MIDDLEBURG HEIGHTS, OH 441303417
Phone: (440) 542-5000
Fax: (440) 542-5005
Type: Location
Saint John Medical Center, 29000, Center Ridge Road, Westlake, Cuyahoga County, Ohio, 44145, United States
WESTLAKE, OH 441455293
Phone: (440) 835-8000
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2003-11-05
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20031105000352 | O | Clinic/Group Practice | OH | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 44145)
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