Individual provider Active NPI

Michelle A. Bacon, NP-C

  • Family Nurse Practitioner
  • Defiance, OH
National Provider Identifier
1225480189
Registry record updated Dec 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN.CN.019949 Issued in OH
Practice address
1400 E 2ND St
Defiance, OH 43512-2440
Phone
(419) 784-1414
Fax
(419) 783-2799
NPI assigned
Jul 4, 2016
Last updated
Dec 19, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2016

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 APRN.CN.019949 OH Primary
Critical Care Medicine Registered Nurse 163WC0200X RN.328238 OH

Addresses

Primary practice location

1400 E 2ND St
Defiance, OH 43512-2440

Mailing address

1400 E 2ND St
Defiance, OH 43512-2440

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
I20170103001646 OH Practitioner - Nurse Practitioner 8729369897 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Medical Partners Northern Region Specialty Care LLCGroup PAC ID 9739585480, 86 clinicians

Practice addresses (Care Compare)

1400 E 2ND St
Defiance, OH 43512-2440
Phone (419) 784-1414

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN.328238OHMDCritical Care Medicine Registered Nurse
APRN.CN.019949OHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Medical Partners Northern Region Specialty Care LLC CurrentSince Sep 1, 2021 Accepting new patients
Mercy Health Physicians North Specialty Care LLC CurrentSince Sep 1, 2021 Accepting new patients
Mercy Health Physicians North Specialty Care LLC CurrentSince Sep 1, 2021 Accepting new patients
Mercy Medical Partners Northern Region LLC CurrentSince Dec 7, 2016 Accepting new patients
Mercy Medical Partners Northern Region LLC CurrentSince Dec 7, 2016 Accepting new patients
Mercy Medical Partners Northern Region Specialty Care LLC CurrentSince Sep 1, 2021 Accepting new patients

Locations

1400 E 2nd St
Defiance, OH 43512
Phone (419) 784-1414

1404 E 2nd St
Defiance, OH 43512
Phone (567) 368-1008

1426 Scott St
Napoleon, OH 43545
Phone (419) 599-5600

1600 E Riverview Ave
Ste 101
Napoleon, OH 43545
Phone (419) 592-8774

2735 Navarre Ave
Oregon, OH 43616
Phone (419) 690-8273

2200 Jefferson Ave
Fl 5
Toledo, OH 43604
Phone (419) 251-9826

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

3900 Sunforest Ct
Ste 240
Toledo, OH 43623
Phone (419) 472-3126

Interoperability endpoints

  • Direct secure messaging: mbacon89010@direct.bsmhealth.org

Organizations & group practices 6

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 1

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": "1467590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482105600000",
    "number": "1225480189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 E 2ND ST",
            "city": "DEFIANCE",
            "state": "OH",
            "postal_code": "435122440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 E 2ND ST",
            "city": "DEFIANCE",
            "state": "OH",
            "postal_code": "435122440",
            "telephone_number": "419-784-1414",
            "fax_number": "419-783-2799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACON",
        "first_name": "MICHELLE",
        "middle_name": "A.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-04",
        "last_updated": "2016-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CN.019949",
            "primary": true
        },
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "OH",
            "license": "RN.328238",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Defiance, OH

Sources for this page

Verify at the official NPI Registry.