Individual provider Active NPI

Mary Anne Conklin Reynolds, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Toledo, OH
National Provider Identifier
1194784942
Registry record updated Jan 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
35.059840 Issued in OH
Practice address
3170 W Central Ave
Toledo, OH 43606-2945
Phone
(419) 534-3500
Fax
(419) 534-2608
NPI assigned
Mar 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 35.059840 OH Primary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 4301406532 MI

Addresses

Primary practice location

3170 W Central Ave
Toledo, OH 43606-2945

Mailing address

3170 W Central Ave
Toledo, OH 43606-2945
Phone (419) 534-3500

Other identifiers 2

IdentifierTypeStateIssuer
0805276MedicaidOH
3030916MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, MI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040709001346 OH Practitioner - Pathology 1456339050 Reassigns benefits to 1 organization
I20080313000540 MI Practitioner - Pathology 1456339050 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
University of Michigan Medical School, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Consultants in Laboratory Medicine of Greater ToledoGroup PAC ID 2860474459, 21 clinicians

Practice addresses (Care Compare)

2142 N Cove Blvd
Toledo, OH 43606-3895
Phone (419) 534-3500

818 Riverside Ave
Adrian, MI 49221-1446
Phone (517) 265-0262

Hospital & facility affiliations

  • Promedica Toledo Hospital Hospital, Toledo, OH, CCN 360068
  • Promedica Charles and Virginia Hickman Hospital Hospital, Adrian, MI, CCN 230005
  • Promedica Monroe Regional Hospital Hospital, Monroe, MI, CCN 230099

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301406532MIMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Haematology-Oncology Associates of Ohio and Michigan PC Current Accepting new patients

Locations

2142 N Cove Blvd
Toledo, OH 43606
Phone (419) 291-1111

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 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": "1142899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420761600000",
    "number": "1194784942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3170 W CENTRAL AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436062945",
            "telephone_number": "419-534-3500",
            "fax_number": "419-534-2608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3170 W CENTRAL AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436062945",
            "telephone_number": "419-534-3500",
            "fax_number": "419-534-2608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONKLIN REYNOLDS",
        "first_name": "MARY ANNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-21",
        "last_updated": "2015-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "OH",
            "license": "35.059840",
            "primary": true
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MI",
            "license": "4301406532",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0805276",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3030916",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.