Individual provider Active NPI

Daniel Fenderson, APRN, CNP

  • Family Nurse Practitioner
  • Toledo, OH
National Provider Identifier
1104390350
Registry record updated Jun 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN.CNP.023196 Issued in OH
Practice address
2109 Hughes Dr # 720
Toledo, OH 43606-3858
Phone
(419) 291-2077
Fax
(419) 291-2122
NPI assigned
Jan 21, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704308778 MI
Family Nurse Practitioner 363LF0000X APRN.CNP.023196 OH Primary

Addresses

Primary practice location

2109 Hughes Dr # 720
Toledo, OH 43606-3858

Mailing address

100 Madison Ave
Toledo, OH 43604-1516

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dfenderson274800@epicdirect.promedica.org Health Information Exchange (HIE)

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
I20210217001934 OH Practitioner - Nurse Practitioner 7012246598 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
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 760
Toledo, OH 43606-5111
Phone (419) 291-7555

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Central Physicians CurrentSince May 23, 2023 Accepting new patients
Promedica Central Physicians CurrentSince May 23, 2023 Accepting new patients

Locations

5901 Monclova Rd
Maumee, OH 43537
Phone (419) 893-5911

5705 Monclova Rd
Maumee, OH 43537
Phone (419) 893-3321

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

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

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

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

2109 Hughes Dr
Ste 760
Toledo, OH 43606
Phone (419) 291-7555

Interoperability endpoints

  • Direct secure messaging: dfenderson274800@direct.promedica.org

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": "1548028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718582400000",
    "number": "1104390350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MADISON AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436041516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2109 HUGHES DR # 720",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436063858",
            "telephone_number": "419-291-2077",
            "fax_number": "419-291-2122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENDERSON",
        "first_name": "DANIEL",
        "credential": "APRN, CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-01-21",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704308778",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.023196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dfenderson274800@epicdirect.promedica.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "2109 Hughes Dr # 720",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436063858",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.