Provider Demographics
| NPI: | 1013942101 |
|---|---|
| Name: | MAYFIELD CLINIC INC |
| Entity Type: | Organization |
| Organization Name: | MAYFIELD CLINIC INC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | VICE PRESIDENT |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | MICHAEL |
| Authorized Official - Middle Name: | J |
| Authorized Official - Last Name: | RADOMSKI |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | VP |
| Authorized Official - Phone: | 513-221-1100 |
| Mailing Address - Street 1: | PO BOX 643398 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | CINCINNATI |
| Mailing Address - State: | OH |
| Mailing Address - Zip Code: | 45264-3398 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 513-221-1100 |
| Mailing Address - Fax: | 513-569-5279 |
| Practice Address - Street 1: | 3825 EDWARDS RD |
| Practice Address - Street 2: | SUITE 300 |
| Practice Address - City: | CINCINNATI |
| Practice Address - State: | OH |
| Practice Address - Zip Code: | 45209-1287 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 513-221-1100 |
| Practice Address - Fax: | 513-569-5279 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-07-11 |
| Last Update Date: | 2024-02-26 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
| No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
| No | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | Group - Multi-Specialty |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 207XS0117X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | Group - Multi-Specialty |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 2081P0004X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Spinal Cord Injury Medicine | Group - Multi-Specialty |
| No | 2081P2900X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | Group - Multi-Specialty |
| No | 2085N0700X | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | Group - Multi-Specialty |
| No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Multi-Specialty |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| KY | 7100347010 | Medicaid | |
| KY | 7100011860 | Medicaid | |
| KY | 7100357630 | Medicaid | |
| KY | 65903387 | Medicaid | |
| IN | 100001460A | Medicaid | |
| OH | 0358723 | Medicaid | |
| KY | CF9178 | Other | RAILROAD MEDICARE |
| OH | CC0892 | Other | RAILROAD MEDICARE |
| OH | 9219571 | Medicare PIN | |
| KY | 5624 | Medicare PIN |
