Individual provider Active NPI

Mary Angela Martin-Williams, NURSE PRACTITIONER

  • Psychiatric/Mental Health Nurse Practitioner
  • Toledo, OH
National Provider Identifier
1174863609
Registry record updated Mar 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
COA.14311-NP Issued in OH
Practice address
2770 Centennial Rd
Toledo, OH 43617-1829
Phone
(419) 794-0567
Fax
(419) 794-0569
NPI assigned
Feb 20, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X COA.14311-NP OH Primary

Addresses

Primary practice location

2770 Centennial Rd
Toledo, OH 43617-1829

Mailing address

2770 Centennial Rd
Toledo, OH 43617-1829
Phone (419) 794-0567

Other identifiers 1

IdentifierTypeStateIssuer
0111053MedicaidOH

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
I20150408002060 OH Practitioner - Nurse Practitioner 8527386200 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of South Alabama College of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Comprehensive Behavioral Health Services LLCGroup PAC ID 2264502541, 16 clinicians

Practice addresses (Care Compare)

2770 Centennial Rd
Toledo, OH 43617-1829
Phone 4197940567122

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
COA.14311-NPOHMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lima Memorial Joint Operating Company Past Accepting new patients

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": "1361318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427241600000",
    "number": "1174863609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2770 CENTENNIAL RD",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436171829",
            "telephone_number": "419-794-0567",
            "fax_number": "419-794-0569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2770 CENTENNIAL RD",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436171829",
            "telephone_number": "419-794-0567",
            "fax_number": "419-794-0569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN-WILLIAMS",
        "first_name": "MARY",
        "middle_name": "ANGELA",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-20",
        "last_updated": "2015-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "COA.14311-NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0111053",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.