Individual provider Active NPI

Timothy McCoy, PA-C

  • Surgical Physician Assistant
  • Toledo, OH
National Provider Identifier
1063415818
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
50000353 Issued in OH
Practice address
2109 Hughes Dr
Ste 720
Toledo, OH 43606-5110
Phone
(419) 291-2077
Fax
(419) 291-2122
NPI assigned
May 24, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 50000353 OH Primary

Addresses

Primary practice location

2109 Hughes Dr
Ste 720
Toledo, OH 43606-5110

Mailing address

2142 N Cove Blvd
9TH Floor
Toledo, OH 43606-3895
Phone (419) 291-5318

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tmccoy13477@epicdirect.promedica.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070612000168 OH Practitioner - Physician Assistant 4789782939 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Promedica Central PhysiciansGroup PAC ID 2365348190, 785 clinicians

Practice addresses (Care Compare)

2109 Hughes Dr
Suite 450
Toledo, OH 43606-5102
Phone (419) 291-2003

2142 N Cove Blvd
Toledo, OH 43606-3895
Phone (419) 291-4000

2901 N Reynolds Rd
Toledo, OH 43606
Phone (419) 578-7700

5200 Harroun Rd
Sylvania, OH 43560-2168
Phone (419) 824-1444

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
50000353OHMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Central Physicians CurrentSince Dec 31, 2015 Accepting new patients
Promedica Central Physicians CurrentSince Dec 31, 2015 Accepting new patients

Locations

5200 Harroun Rd
Sylvania, OH 43560
Phone (419) 824-1305

2109 Hughes Dr
Ste 720
Toledo, OH 43606
Phone (419) 291-2077

100 Madison Ave
Toledo, OH 43604
Phone (567) 585-1964

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

2109 Hughes Dr
Ste 450
Toledo, OH 43606
Phone (419) 251-3112

2142 N Cove Blvd
Fl 9
Toledo, OH 43606

Interoperability endpoints

  • Direct secure messaging: tmccoy13477@direct.promedica.org
  • Direct secure messaging: timothy.mccoy.1@31768.direct.athenahealth.com

Organizations & group practices 2

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 2

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": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1063415818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2142 N COVE BLVD",
            "address_2": "9TH FLOOR",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436063895",
            "telephone_number": "419-291-5318",
            "fax_number": "419-291-6430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2109 HUGHES DR",
            "address_2": "STE 720",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436065110",
            "telephone_number": "419-291-2077",
            "fax_number": "419-291-2122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCOY",
        "first_name": "TIMOTHY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OH",
            "license": "50000353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tmccoy13477@epicdirect.promedica.org",
            "affiliation": "N",
            "address_1": "100 Madison Ave",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436041516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.