| Cityblock Medical Practice, Llc | |
|
6100 E Main St Ste 110 Columbus OH 43213-3399 | |
| (833) 904-0620 | |
| Not Available |
| Full Name | Cityblock Medical Practice, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6100 E Main St Ste 110, Columbus, Ohio |
| Authorized Official Name and Position | Susan Brown (CHIEF ADMINISTRATIVE OFFICER) |
| Authorized Official Contact | 8339040620 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cityblock Medical Practice, Llc 495 Flatbush Ave Ste C5 Brooklyn NY 11225-3706 Ph: () - | Cityblock Medical Practice, Llc 6100 E Main St Ste 110 Columbus OH 43213-3399 Ph: (833) 904-0620 |
| NPI Number | 1013673821 |
|---|---|
| Provider Enumeration Date | 11/16/2021 |
| Last Update Date | 01/19/2023 |
| Medicare PECOS PAC ID | 4688059645 |
|---|---|
| Medicare Enrollment ID | O20220913000283 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013673821 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Tonya M Carter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720218654 PECOS PAC ID: 6002952876 Enrollment ID: I20091008000075 |
| Provider Name | Jasmine D Usher Ledet |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376794263 PECOS PAC ID: 1951566058 Enrollment ID: I20120622000059 |
| Provider Name | Juliana Watts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225418825 PECOS PAC ID: 1355659376 Enrollment ID: I20150924001614 |
| Provider Name | Steven Schneider |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871559385 PECOS PAC ID: 0446225635 Enrollment ID: I20160405000757 |
| Provider Name | Tiana Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598124562 PECOS PAC ID: 3173821055 Enrollment ID: I20160408000764 |
| Provider Name | Sophia Hammonds |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417330085 PECOS PAC ID: 3678874724 Enrollment ID: I20170818001603 |
| Provider Name | Jaimee K Colvin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346758729 PECOS PAC ID: 7911267422 Enrollment ID: I20180201000383 |
| Provider Name | Barbara Parkes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689926222 PECOS PAC ID: 9133447386 Enrollment ID: I20200507003238 |
| Provider Name | Nicole Lavon-renee Campbell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104452051 PECOS PAC ID: 8325461593 Enrollment ID: I20200706003163 |
| Provider Name | Stephen Kelly |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1558504258 PECOS PAC ID: 7113185117 Enrollment ID: I20200819003471 |
| Provider Name | Monica Mackey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740745702 PECOS PAC ID: 5698192417 Enrollment ID: I20210126001178 |
| Provider Name | Shadrie Munir Sahaag |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194468892 PECOS PAC ID: 8325428816 Enrollment ID: I20220629003625 |
| Provider Name | Robert Scott Jordan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316966419 PECOS PAC ID: 3274539952 Enrollment ID: I20220912002752 |
| Provider Name | Neema Hooker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457747842 PECOS PAC ID: 7113207457 Enrollment ID: I20220913000478 |
| Provider Name | Holly Oh |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1063497311 PECOS PAC ID: 4284765744 Enrollment ID: I20220913000588 |
| Provider Name | Michael Tang |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598932097 PECOS PAC ID: 8729259197 Enrollment ID: I20220913000636 |
| Provider Name | Dhruva Kothari |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063771574 PECOS PAC ID: 6305149154 Enrollment ID: I20220913000892 |
| Provider Name | Kameron Matthews |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902028822 PECOS PAC ID: 0749461317 Enrollment ID: I20220913000975 |
| Provider Name | Sheila Turbides Minaya |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841506375 PECOS PAC ID: 3779725015 Enrollment ID: I20220913001081 |
| Provider Name | Jessica Ramos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043704851 PECOS PAC ID: 9133462922 Enrollment ID: I20220913001169 |
| Provider Name | Amir Darvish |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1386717783 PECOS PAC ID: 2567557952 Enrollment ID: I20220913001252 |
| Provider Name | Britt-marie Cables |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164791851 PECOS PAC ID: 0941465934 Enrollment ID: I20220913003461 |
| Provider Name | Jerri Dawn Steele |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568120491 PECOS PAC ID: 8820473606 Enrollment ID: I20220914002289 |
| Provider Name | Mohanne Charles |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194281691 PECOS PAC ID: 1557602943 Enrollment ID: I20220915000694 |
| Provider Name | Oluwatoyin Ajayi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790912426 PECOS PAC ID: 7517115298 Enrollment ID: I20220915000744 |
| Provider Name | Rebecca Cooper-mccann |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407234222 PECOS PAC ID: 5799039590 Enrollment ID: I20220915001018 |
| Provider Name | Roxanne Chase-wiley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336395532 PECOS PAC ID: 3779626288 Enrollment ID: I20220915002047 |
| Provider Name | Sharda Mukunda |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811256019 PECOS PAC ID: 5193957538 Enrollment ID: I20220915002176 |
| Provider Name | Abena Adoma Oteng |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801441084 PECOS PAC ID: 9830574599 Enrollment ID: I20220915002537 |
| Provider Name | David Dayan-rosenman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992083885 PECOS PAC ID: 4385940113 Enrollment ID: I20220915003143 |
| Provider Name | Shanyq Salop |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801352711 PECOS PAC ID: 0840523338 Enrollment ID: I20220916000971 |
| Provider Name | Charlene Scotton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164934394 PECOS PAC ID: 6709147473 Enrollment ID: I20220916001981 |
| Provider Name | David Gurley |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1457577751 PECOS PAC ID: 1355433780 Enrollment ID: I20220916003014 |
| Provider Name | Claritza Rios |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841354164 PECOS PAC ID: 8123109592 Enrollment ID: I20220919000354 |
| Provider Name | Kaya Daley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972929602 PECOS PAC ID: 2668605361 Enrollment ID: I20220919002151 |
| Provider Name | Melissa Strader |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649928300 PECOS PAC ID: 4385029818 Enrollment ID: I20220919002692 |
| Provider Name | Ruby Mehta |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063813897 PECOS PAC ID: 0547652554 Enrollment ID: I20220920001019 |
| Provider Name | Isaac Wright |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417322561 PECOS PAC ID: 9335524818 Enrollment ID: I20220920001192 |
| Provider Name | Patricia Nicole Bryan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205308418 PECOS PAC ID: 0648603506 Enrollment ID: I20220920002345 |
| Provider Name | Scott Gremillion |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306232004 PECOS PAC ID: 0345520540 Enrollment ID: I20220923001193 |
| Provider Name | William Jackson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1316068497 PECOS PAC ID: 3274600580 Enrollment ID: I20220923001213 |
| Provider Name | Mariama Hubbard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518946763 PECOS PAC ID: 8628033156 Enrollment ID: I20220923002278 |
| Provider Name | Alice Robertson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669854287 PECOS PAC ID: 4284060864 Enrollment ID: I20220926001486 |
| Provider Name | Kimberly K Swiecki |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548734320 PECOS PAC ID: 0143561134 Enrollment ID: I20221004001751 |
| Provider Name | Emily Hurwitz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710324397 PECOS PAC ID: 3678860483 Enrollment ID: I20221005002567 |
| Provider Name | Joseph Truett |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437681863 PECOS PAC ID: 8820368558 Enrollment ID: I20221006001278 |
| Provider Name | Elizabeth Blazey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841867967 PECOS PAC ID: 4880090299 Enrollment ID: I20221122001452 |
| Provider Name | Snehal Patel |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1528306586 PECOS PAC ID: 9436469657 Enrollment ID: I20221206002563 |
| Provider Name | Rebecca Simons |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285767459 PECOS PAC ID: 3476539271 Enrollment ID: I20221207000315 |
| Provider Name | Samamtha Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033340377 PECOS PAC ID: 9436297645 Enrollment ID: I20221208001016 |
| Provider Name | Sarah Updegraff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730671462 PECOS PAC ID: 6103171293 Enrollment ID: I20221228002167 |
| Provider Name | Chidinma D Kabba |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1659647873 PECOS PAC ID: 1759671662 Enrollment ID: I20230301001855 |
| Provider Name | Steven Spencer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023057007 PECOS PAC ID: 8325051253 Enrollment ID: I20230317000220 |
| Provider Name | Andrew Keyser |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1225442023 PECOS PAC ID: 8921375130 Enrollment ID: I20230317001332 |
| Provider Name | Bennie Taylor |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154777019 PECOS PAC ID: 4486941101 Enrollment ID: I20230322002314 |
| Provider Name | Svetlana Borochin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609128149 PECOS PAC ID: 8628217312 Enrollment ID: I20230425000553 |
| Provider Name | Pooja Mehta |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1083841316 PECOS PAC ID: 4880837848 Enrollment ID: I20230503002442 |
| Provider Name | Elizabeth Gray |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962079269 PECOS PAC ID: 4981051158 Enrollment ID: I20231109000439 |
| Provider Name | Nichole Lewis |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1528206729 PECOS PAC ID: 6709034036 Enrollment ID: I20231114002190 |
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