NPIMap

Individual provider Active NPI

Susan M Federman, MD

  • Family Medicine Physician
  • Toledo, OH
National Provider Identifier
1063405033
Registry record updated Mar 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35059184 Issued in OH
Practice address
3425 Executive Pkwy Ste 117
Toledo, OH 43606-1333
Phone
(419) 469-2102
NPI assigned
Aug 25, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35.059184 OH
Family Medicine Physician 207Q00000X 35059184 OH Primary

Addresses

Primary practice location

3425 Executive Pkwy Ste 117
Toledo, OH 43606-1333

Mailing address

4235 Secor Rd
Toledo, OH 43623-4231
Phone (419) 843-3627

Other practice location 1

3909 Woodley Rd
Suite 500
Toledo, OH 43606-1169
Phone (419) 291-2670

Other identifiers 1

IdentifierTypeStateIssuer
0841405MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100422001152 OH Practitioner - Family Practice 8628105624 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Ohio, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

3425 Executive Pkwy
Toledo, OH 43606-1333

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35059184OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Toledo Clinic Incorporated Family Medicine CurrentSince Aug 15, 2013 Accepting new patients
Federman Wellcare, LLC Family Medicine Current Accepting new patients
Toledo Clinic Incorporated CurrentSince Aug 15, 2013 Accepting new patients
Toledo Clinic Incorporated Current Accepting new patients
Toledo Clinic Incorporated Past Accepting new patients

Locations

3425 Executive Pkwy
Ste 117
Toledo, OH 43606
Phone (419) 469-2102

4411 N Holland Sylvania Rd
Ste 201
Toledo, OH 43623
Phone (419) 843-3627

4235 Secor Rd
Toledo, OH 43623
Phone (419) 214-4214

2142 N Cove Blvd
Toledo, OH 43606
Phone (419) 291-1111

Interoperability endpoints

  • Direct secure messaging: susan.federman@toledoclinic.eclinicaldirectplus.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585180800000",
    "number": "1063405033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4235 SECOR RD",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436234231",
            "telephone_number": "419-843-3627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3425 EXECUTIVE PKWY STE 117",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436061333",
            "telephone_number": "419-469-2102"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3909 Woodley Rd",
            "address_2": "Suite 500",
            "address_purpose": "LOCATION",
            "city": "Toledo",
            "state": "OH",
            "postal_code": "436061169",
            "country_code": "US",
            "telephone_number": "419-291-2670",
            "fax_number": "419-479-6999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FEDERMAN",
        "first_name": "SUSAN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-25",
        "last_updated": "2020-03-26",
        "certification_date": "2020-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.059184",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35059184",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0841405",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.