Individual provider Active NPI

Prentis Lee Holmes, LISW-S

  • Clinical Social Worker
  • Toledo, OH
National Provider Identifier
1063784973
Registry record updated Jul 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I0700407 Issued in OH
Practice address
2005 Ashland Ave
Toledo, OH 43620-1703
Phone
(419) 841-7701
NPI assigned
Feb 8, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X I0700407 OH Primary

Addresses

Primary practice location

2005 Ashland Ave
Toledo, OH 43620-1703

Mailing address

2005 Ashland Ave
Toledo, OH 43620-1703
Phone (419) 841-7701

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150615002370 OH Practitioner - Clinical Social Worker 5092026237 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
University of Michigan Medical School, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Zepf CenterGroup PAC ID 5395639215, 43 clinicians

Practice addresses (Care Compare)

2005 Ashland Ave
Toledo, OH 43620-1703
Phone (419) 841-7701

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
I0700407OHMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Zepf Center CurrentSince Jul 1, 2021 Accepting new patients
Zepf Center CurrentSince Jul 1, 2021 Accepting new patients

Locations

2005 Ashland Ave
Toledo, OH 43620
Phone (419) 255-3040

6605 W Central Ave
Ste 100
Toledo, OH 43617
Phone 41984177012235

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.

NPI Registry JSON

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

{
    "created_epoch": "1328659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625097600000",
    "number": "1063784973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2005 ASHLAND AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436201703",
            "telephone_number": "419-841-7701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 ASHLAND AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436201703",
            "telephone_number": "419-841-7701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMES",
        "first_name": "PRENTIS",
        "middle_name": "LEE",
        "credential": "LISW-S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-02-08",
        "last_updated": "2021-07-01",
        "certification_date": "2021-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I0700407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.