NPIMap

Individual provider Active NPI

Joel Sobecki

  • Family Nurse Practitioner
  • Fostoria, OH
National Provider Identifier
1104181197
Registry record updated May 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
COA.13466-NP Issued in OH
Practice address
455 W 4TH St
Suite 100
Fostoria, OH 44830-1849
Phone
(419) 436-6680
Fax
(419) 436-6681
NPI assigned
Jul 6, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X COA.13466-NP OH Primary

Addresses

Primary practice location

455 W 4TH St
Suite 100
Fostoria, OH 44830-1849

Mailing address

455 W 4TH St
Suite 100
Fostoria, OH 44830-1849
Phone (419) 436-6680

Other identifiers 1

IdentifierTypeStateIssuer
0068742MedicaidOH

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
I20120813000512 OH Practitioner - Nurse Practitioner 2466608161 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Professional Services LTDGroup PAC ID 1456531870, 40 clinicians

Practice addresses (Care Compare)

715 S Taft Ave
Fremont, OH 43420-3237
Phone (419) 333-6462

Hospital & facility affiliations

  • Med1Care, LLC Home health agency, Findlay, OH, CCN 368362
  • Bridge Home Health and Hospice Home health agency, Findlay, OH, CCN 367102
  • Elara Caring Home health agency, Toledo, OH, CCN 367730
  • Fostoria Community Hospital Hospital, Fostoria, OH, CCN 361318
  • Promedica Toledo Hospital Hospital, Toledo, OH, CCN 360068
  • Memorial Hospital Hospital, Fremont, OH, CCN 360156
  • Mercy Health - Tiffin Hospital Hospital, Tiffin, OH, CCN 360089

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN.CNP.134OHMDFamily Nurse Practitioner
COA.13466-NPOHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Central Physicians CurrentSince Dec 31, 2014 Accepting new patients
Memorial Professional Services LTD CurrentSince Jan 1, 2018 Accepting new patients
Promedica Central Physicians CurrentSince Dec 31, 2014 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

455 W 4th St
Ste 100
Fostoria, OH 44830
Phone (419) 436-6680

715 S Taft Ave
Fremont, OH 43420
Phone (419) 332-7321

650 Beaver Creek Cir
Ste 130
Maumee, OH 43537
Phone (419) 891-6210

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

Interoperability endpoints

  • Direct secure messaging: jsobecki30895@direct.promedica.org

Organizations & group practices 4

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 8

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": "1341532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368748800000",
    "number": "1104181197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 W 4TH ST",
            "address_2": "SUITE 100",
            "city": "FOSTORIA",
            "state": "OH",
            "postal_code": "448301849",
            "telephone_number": "419-436-6680",
            "fax_number": "419-436-6681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 W 4TH ST",
            "address_2": "SUITE 100",
            "city": "FOSTORIA",
            "state": "OH",
            "postal_code": "448301849",
            "telephone_number": "419-436-6680",
            "fax_number": "419-436-6681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOBECKI",
        "first_name": "JOEL",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-06",
        "last_updated": "2013-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "COA.13466-NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0068742",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fostoria, OH

Sources for this page

Verify at the official NPI Registry.