OSUP COMMUNITY OUTREACH, LLC (NPI# 1699179929) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699179929 |
| Entity Type | Organization |
| Organization Name | OSUP COMMUNITY OUTREACH, LLC |
| Practice Address |
5109 W Broad St Columbus OH 43228-1648 |
| Mailing Address |
700 Ackerman Rd Ste 2120 Columbus OH 43202-1559 |
| Practice Telephone | 6148703669 |
| Practice Fax Number | 6148703449 |
| Mailing Telephone | 6146854601 |
| Mailing Fax Number | 6143663731 |
| Enumeration Date | 2014-10-15 |
| Last Update Date | 2019-10-14 |
| Authorized Official Name | MR. KYLE L. SHARP (ASSOCIATE EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 6142933202 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | RAILROAD MEDICARE | DV2507 | 01 |
| OH | 0112258 | 05 |
| Street Address |
5109 W BROAD ST |
| City | COLUMBUS |
| State | OH |
| Zip Code | 43228-1648 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629056775 | Scott Jonathan Nicolette | Dentist | 5109 W Broad St, 202, Columbus, OH 43228-1648 | 2006-01-07 |
| 1689215840 | Monica Marcotte | Counselor | 5109 W Broad St, Columbus, OH 43228-1648 | 2019-09-30 |
| 1588150023 | Mariah Shay Mercer-ranson | Case Manager/Care Coordinator | 5109 W Broad St, Columbus, OH 43228-1648 | 2018-07-09 |
| 1417494899 | Emma Grace Rodriguez | Social Worker | 5109 W Broad St, Suite 104, Columbus, OH 43228 | 2017-01-24 |
| 1679017172 | Jill E Witteman | Social Worker | 5109 W Broad St, Columbus, OH 43228-1648 | 2016-12-19 |
| 1023564168 | Anastasia Collier | Social Worker | 5109 W Broad St, 104, Columbus, OH 43228-1648 | 2016-08-29 |
| 1720448905 | Shaunae Tolson | Case Manager/Care Coordinator | 5109 W Broad St, Suite 104, Columbus, OH 43228-1648 | 2016-03-01 |
| 1174983365 | Danielle Nicole Smart | Social Worker | 5109 W Broad St, Suite 104, Columbus, OH 43228-1648 | 2016-03-01 |
| 1801256516 | Brandi Harrison | Social Worker | 5109 W Broad St, Columbus, OH 43228-1648 | 2016-02-24 |
| 1275992166 | Dana Mullis | Social Worker | 5109 W Broad St, Suite 104, Columbus, OH 43228-1648 | 2016-02-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629694229 | The Laurels of West Columbus, LLC | Skilled Nursing Facility | 441 Norton Rd, Columbus, OH 43228 | 2020-06-19 |
| 1538788146 | Colin Rogers | Student in an Organized Health Care Education/Training Program | Ohiohealth Doctors Hospital, 5100 West Broad Street, Columbus, OH 43228 | 2020-04-14 |
| 1093343899 | Cameron Alvin Gachett | Student in an Organized Health Care Education/Training Program | Ohiohealth Doctors Hospital Community Medicine Clinic, 50 Old Village Road, Columbus, OH 43228 | 2020-03-29 |
| 1407483431 | Zachary Werner | Student in an Organized Health Care Education/Training Program | Ohio Health Doctors Hospital, 5100 West Broad Street, Columbus, OH 43228 | 2020-03-27 |
| 1831684232 | Medcare Clinic LLC | Clinic/Center | 4125 W Broad St, Columbus, OH 43228 | 2018-06-27 |
| 1952893950 | Midland Medical Group, LLC | Family Medicine | 1000 Georgesville Rd, Columbus, OH 43228 | 2018-06-05 |
| 1619478336 | Charles Norris Fennie | Student in an Organized Health Care Education/Training Program | Doctors Hospital Community Medicine Clinic, 50 Old Village Road, Columbus, OH 43228 | 2018-02-27 |
| 1902304389 | Icare Health & Wellness Medical Center, LLC | Counselor | 5152 W.broad St, Suite A, Columbus, OH 43228 | 2018-01-31 |
| 1104334523 | Inner Health Chiropractic, Inc | Chiropractor | 5125 West Broad Street, Inner Health Chiropractic, Columbus, OH 43228 | 2018-01-19 |
| 1205363777 | Optum Infusion Services 500, Inc. | Durable Medical Equipment & Medical Supplies | 2182 Dividend Drive, Columbus, OH 43228 | 2017-05-16 |
| Find all providers in zip 43228 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174059174 | Padet Wattanasarn | Psychiatry & Neurology | 1070 Circle On The Grn, Columbus, OH 43235-1211 | 2017-05-11 |
| 1780946731 | Samantha Jo Lorusso | Psychiatry & Neurology | 543 Taylor Ave Ste 1100, Columbus, OH 43203-1278 | 2012-06-14 |
| 1184930133 | Appaji Rayi | Psychiatry & Neurology | 395 W 12th Ave Fl 7, Columbus, OH 43210 | 2010-08-27 |
| 1760641740 | Aaron Lee Boster | Psychiatry & Neurology | 8000 Ravines Edge Ct Ste 200, Columbus, OH 43235-5422 | 2008-06-05 |
| 1740489566 | Neurological Associates, Inc. | Psychiatry & Neurology | 974 Bethel Rd Ste C, Columbus, OH 43214-2467 | 2007-07-12 |
| 1649488586 | Shuang Chen | Psychiatry & Neurology | 4551 Lanercost Way, Columbus, OH 43220-2916 | 2007-05-21 |
| 1538222609 | George Wesley Paulson | Psychiatry & Neurology | 3957 Lytham Ct, Columbus, OH 43220-4848 | 2006-12-19 |
| 1740355486 | Brien John Smith | Psychiatry & Neurology | 3555 Olentangy River Rd Ste 2002, Columbus, OH 43214 | 2006-11-21 |
| 1144304064 | Maria Kataki | Psychiatry & Neurology | 2050 Kenny Rd Fl 3, Columbus, OH 43221-3502 | 2006-10-25 |
| 1205910502 | Douglas W. Scharre | Psychiatry & Neurology | 2050 Kenny Rd Fl 7, Columbus, OH 43221-3502 | 2006-10-24 |
| Find all providers in COLUMBUS | ||||
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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.