Individual provider Active NPI

Kelly Zielinski-Inthanamith, NP

  • Nurse Practitioner
  • Toledo, OH
National Provider Identifier
1225334667
Registry record updated Dec 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
COA11819NP Issued in OH
Practice address
1421S Reynolds Rd
Toledo, OH 43615-7413
Phone
(419) 725-6290
Fax
(419) 725-6287
NPI assigned
Feb 2, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X COA11819NP OH Primary

Addresses

Primary practice location

1421S Reynolds Rd
Toledo, OH 43615-7413

Mailing address

1421S Reynolds Rd
Toledo, OH 43615-7413
Phone (419) 725-6290

Other identifiers 1

IdentifierTypeStateIssuer
0056043MedicaidOH

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
I20120224000734 OH Practitioner - Nurse Practitioner 4789842592 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
COA11819NPOHMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Vpa PC CurrentSince Jan 14, 2018 Accepting new patients
Vpa PC Current Accepting new patients
Vpa PC CurrentSince Jan 14, 2018 Accepting new patients

Locations

1900 Indian Wood Cir
Ste 202B
Maumee, OH 43537
Phone (419) 578-8594

7350 Industrial Park Blvd
Mentor, OH 44060
Phone (216) 732-9480

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 and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1296604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450742400000",
    "number": "1225334667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1421S REYNOLDS RD",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436157413",
            "telephone_number": "419-725-6290",
            "fax_number": "419-725-6287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421S REYNOLDS RD",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436157413",
            "telephone_number": "419-725-6290",
            "fax_number": "419-725-6287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZIELINSKI-INTHANAMITH",
        "first_name": "KELLY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-02",
        "last_updated": "2015-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "COA11819NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0056043",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.