NPIMap

Individual provider Active NPI

Brenton M Hall, CNP

  • Family Nurse Practitioner
  • Tiffin, OH
National Provider Identifier
1114519873
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN.CNP.0028349 Issued in OH
Practice address
27 St Lawrence Dr Ste 103
Tiffin, OH 44883-8313
Phone
(419) 448-4622
Fax
(419) 448-4808
NPI assigned
Feb 4, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 0028349 OH
Family Nurse Practitioner 363LF0000X APRN.CNP.0028349 OH Primary

Addresses

Primary practice location

27 St Lawrence Dr Ste 103
Tiffin, OH 44883-8313

Mailing address

27 St Lawrence Dr Ste 103
Tiffin, OH 44883-8313

Other names 1

  • Brent M Hall Other name

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
I20210222000996 OH Practitioner - Nurse Practitioner 8921413113 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Health Physicians-North LLCGroup PAC ID 2668522400, 131 clinicians

Practice addresses (Care Compare)

27 St Lawrence Dr
Suite 103
Tiffin, OH 44883-8313
Phone (419) 448-4622

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0028349OHMDNurse Practitioner
APRN.CNP.0028349OHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Physicians-North LLC CurrentSince Oct 14, 2024 Accepting new patients
Mercy Health Physicians - North, LLC CurrentSince Oct 14, 2024 Accepting new patients
Mercy Health System Northern Past Accepting new patients

Locations

27 St Lawrence Dr
Ste 103
Tiffin, OH 44883
Phone (419) 448-4622

2222 Cherry St
Ste 2300
Toledo, OH 43608
Phone (419) 251-8013

Interoperability endpoints

  • Direct secure messaging: bhall804423@direct.bsmhealth.org

Organizations & group practices 3

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

Hospital & facility affiliations 5

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": "1612396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730332800000",
    "number": "1114519873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 ST LAWRENCE DR STE 103",
            "city": "TIFFIN",
            "state": "OH",
            "postal_code": "448838313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27 ST LAWRENCE DR STE 103",
            "city": "TIFFIN",
            "state": "OH",
            "postal_code": "448838313",
            "telephone_number": "419-448-4622",
            "fax_number": "419-448-4808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALL",
        "first_name": "BRENTON",
        "middle_name": "M",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-04",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "0028349",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.0028349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRENT",
            "last_name": "HALL",
            "middle_name": "M",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Tiffin, OH

Sources for this page

Verify at the official NPI Registry.