| 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 | 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 |
| Certification 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 | (NU) | 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 | 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 Colvin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346758729 PECOS PAC ID: 7911267422 Enrollment ID: I20180201000383 |
| 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 | Christian Nkenglefac |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851058770 PECOS PAC ID: 9830582329 Enrollment ID: I20220204001013 |
| Provider Name | Laura Connor |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1366875064 PECOS PAC ID: 3971732330 Enrollment ID: I20220208002363 |
| Provider Name | Shadrie Munir Sahaag |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194468892 PECOS PAC ID: 8325428816 Enrollment ID: I20220629003625 |
| Provider Name | Neema Hooker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457747842 PECOS PAC ID: 7113207457 Enrollment ID: I20220913000478 |
| Provider Name | Stacy Abrams |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1386714491 PECOS PAC ID: 0749230530 Enrollment ID: I20220913000544 |
| Provider Name | Janie Cloin |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1184840225 PECOS PAC ID: 3274625645 Enrollment ID: I20220913000561 |
| Provider Name | Sylvia Brandenberg |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1093284200 PECOS PAC ID: 8729327853 Enrollment ID: I20220913000586 |
| 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 | Vera Mccullen |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1962734616 PECOS PAC ID: 0042342768 Enrollment ID: I20220913000801 |
| 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 | 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 | Philip Jocelyn |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1841622784 PECOS PAC ID: 3476788092 Enrollment ID: I20220913001273 |
| Provider Name | Britt-marie Cables |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164791851 PECOS PAC ID: 0941465934 Enrollment ID: I20220913003461 |
| Provider Name | Oluwatoyin T Ajayi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790912426 PECOS PAC ID: 7517115298 Enrollment ID: I20220915000744 |
| Provider Name | Roxanne Chase-wiley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336395532 PECOS PAC ID: 3779626288 Enrollment ID: I20220915002047 |
| Provider Name | Abena Oteng |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801441084 PECOS PAC ID: 9830574599 Enrollment ID: I20220915002537 |
| 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 | 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 | Phyllis Young |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1689785156 PECOS PAC ID: 2961459615 Enrollment ID: I20220920001413 |
| Provider Name | Daniel Mcguire |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1083181085 PECOS PAC ID: 0446599476 Enrollment ID: I20220920002615 |
| Provider Name | William Jackson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1316068497 PECOS PAC ID: 3274600580 Enrollment ID: I20220923001213 |
| Provider Name | Mariama Patricia 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 | 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 | Samantha Fay Singer |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1255684353 PECOS PAC ID: 0244482750 Enrollment ID: I20230227000806 |
| Provider Name | Chidinma Dawn Kabba |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1659647873 PECOS PAC ID: 1759671662 Enrollment ID: I20230301001855 |
| Provider Name | Andrew Keyser |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1225442023 PECOS PAC ID: 8921375130 Enrollment ID: I20230317001332 |
| Provider Name | Tracey Brebner |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1386665271 PECOS PAC ID: 0547362584 Enrollment ID: I20230320001742 |
| Provider Name | Bennie Taylor |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154777019 PECOS PAC ID: 4486941101 Enrollment ID: I20230322002314 |
| Provider Name | Vladimir Ristich |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1235528720 PECOS PAC ID: 2567788953 Enrollment ID: I20230328001561 |
| Provider Name | Pooja Mehta |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1083841316 PECOS PAC ID: 4880837848 Enrollment ID: I20230503002442 |
| Provider Name | Jessica Pulliam |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1467653790 PECOS PAC ID: 1557443629 Enrollment ID: I20230606002655 |
| Provider Name | Alexis Diaz-ramos |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1669836706 PECOS PAC ID: 0345537361 Enrollment ID: I20230614000598 |
| 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 |
| Provider Name | Jason Depasquale |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1053714188 PECOS PAC ID: 8820419435 Enrollment ID: I20240127000362 |
| Provider Name | Corey Scott Yilmaz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1972703569 PECOS PAC ID: 8628161049 Enrollment ID: I20240319000720 |
| Provider Name | Megan Tosato |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1831628569 PECOS PAC ID: 4082987078 Enrollment ID: I20240401000074 |
| Provider Name | Talia Pearl |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538816657 PECOS PAC ID: 6608310974 Enrollment ID: I20240627001058 |
| Provider Name | Rina Garcia |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841415718 PECOS PAC ID: 5496841918 Enrollment ID: I20240918000284 |
| Provider Name | Jessica Lane |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497522502 PECOS PAC ID: 0143754481 Enrollment ID: I20241109000284 |
| Provider Name | Ricky Michel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396079562 PECOS PAC ID: 3375938673 Enrollment ID: I20241123000382 |
| Provider Name | Sam Crowning |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1285182766 PECOS PAC ID: 1153600168 Enrollment ID: I20241213000030 |
| Provider Name | Marney Gruber |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1083857601 PECOS PAC ID: 9830345867 Enrollment ID: I20250211003447 |
| Provider Name | Maria Duda |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033315759 PECOS PAC ID: 9133213937 Enrollment ID: I20250402000503 |
| Provider Name | Rachael Weiner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659777522 PECOS PAC ID: 3476834961 Enrollment ID: I20250403002115 |
| Provider Name | Jaime Bristow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598250797 PECOS PAC ID: 5698029726 Enrollment ID: I20250408001405 |
| Provider Name | Sherri Parker |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1356304968 PECOS PAC ID: 4880594621 Enrollment ID: I20250415001704 |
| Provider Name | Yavar Moghimi |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1982879185 PECOS PAC ID: 8325216294 Enrollment ID: I20250429002777 |
| Provider Name | Sunil Shroff |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1164457875 PECOS PAC ID: 8224929831 Enrollment ID: I20250530000942 |
| Provider Name | Ashley Bell |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1336432046 PECOS PAC ID: 6305018649 Enrollment ID: I20250709002926 |
| Provider Name | Janice Marie Spencer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487619102 PECOS PAC ID: 8224280508 Enrollment ID: I20250813003079 |
| Provider Name | William Garcia |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1952728156 PECOS PAC ID: 0446527055 Enrollment ID: I20250819003072 |
| Provider Name | Angel Colon-molero |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063415727 PECOS PAC ID: 3971018813 Enrollment ID: I20251007001989 |
| Provider Name | Jeanne-marie Ngantcha Nkenglefac |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316811698 PECOS PAC ID: 4385134162 Enrollment ID: I20251110001499 |
| Provider Name | Laura Sander |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386806966 PECOS PAC ID: 2264608363 Enrollment ID: I20260116003672 |
| Provider Name | Latoyia Austin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336678192 PECOS PAC ID: 4789917501 Enrollment ID: I20260129001540 |
| Provider Name | Tracey W Alphin |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1194094375 PECOS PAC ID: 4385810076 Enrollment ID: I20260131000111 |
| Provider Name | Arianne Tellez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679234413 PECOS PAC ID: 8123406550 Enrollment ID: I20260407003209 |
| Provider Name | Laura Androski Santoso |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033679246 PECOS PAC ID: 6709243116 Enrollment ID: I20260623002898 |
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