MEDICARE: HEARTLAND REGENERATION GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1801755152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND REGENERATION GROUP LLC

Provider Business Mailing Address
First Line	:	5010 MAYFIELD RD STE 212
Second Line	:
City	:	LYNDHURST
State	:	OH
Zip	:	44124-2692
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5010 MAYFIELD RD STE 212
Second Line	:
City	:	LYNDHURST
State	:	OH
Zip	:	44124-2692
Country	:	US
Telephone Number	:	216-224-6402
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	JORDAN TISDALE
Credential	:
Telephone Number	:	216-224-6402

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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Directions to “HEARTLAND REGENERATION GROUP LLC ” Practice Location

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