Individual provider Active NPI

Ahmed Elisa, MD

  • Allergy & Immunology Physician
  • Perrysburg, OH
National Provider Identifier
1245768738
Registry record updated Nov 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
License
35.147046 Issued in OH
Practice address
1620 Brigham Dr Ste 130
Perrysburg, OH 43551-7124
Phone
(419) 893-7211
Fax
(419) 893-8882
NPI assigned
May 26, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology Physician 207K00000X 4301502151 MI
Pediatrics Physician 208000000X 4301502151 MI
Allergy & Immunology Physician 207K00000X 35.147046 OH Primary

Addresses

Primary practice location

1620 Brigham Dr Ste 130
Perrysburg, OH 43551-7124

Mailing address

100 Madison Ave
Toledo, OH 43604-1516

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address aelisa261884@epicdirect.promedica.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, OH2 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
I20220127000127 MI Practitioner - Pediatric MedicinePractitioner - Allergy/Immunology 7416225172 Reassigns benefits to 1 organization
I20230908000937 OH Practitioner - Pediatric Medicine 7416225172 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Promedica Central PhysiciansGroup PAC ID 2365348190, 785 clinicians

Practice addresses (Care Compare)

1601 Brigham Dr
Suite 150
Perrysburg, OH 43551-7120
Phone (419) 872-7246

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301502151MIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Central Physicians CurrentSince Jul 25, 2023 Accepting new patients
The Allergy Suite Allergy & Immunology CurrentSince Mar 1, 2022 Accepting new patients
Promedica Central Physicians CurrentSince Jul 25, 2023 Accepting new patients
Vitality Nutrition PastSince Mar 1, 2022 Accepting new patients

Locations

39595 W 10 Mile Rd
Ste 111
Novi, MI 48375
Phone (248) 346-2945

5705 Monclova Rd
Ste 205
Maumee, OH 43537
Phone (419) 482-6800

1620 Brigham Dr
Ste 130
Perrysburg, OH 43551
Phone (419) 893-7211

1601 Brigham Dr
Ste 150
Perrysburg, OH 43551
Phone (419) 794-7700

333 N Summit St
Fl 7
Toledo, OH 43604
Phone (419) 252-5909

2109 Hughes Dr
Ste 450
Toledo, OH 43606
Phone (419) 251-3112

100 Madison Ave
Toledo, OH 43604
Phone (567) 585-1964

Interoperability endpoints

  • Direct secure messaging: aelisa654569@direct.hfhs.org

Organizations & group practices 4

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 2

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": "1495756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699488000000",
    "number": "1245768738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MADISON AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436041516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 BRIGHAM DR STE 130",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435517124",
            "telephone_number": "419-893-7211",
            "fax_number": "419-893-8882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELISA",
        "first_name": "AHMED",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-26",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "MI",
            "license": "4301502151",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301502151",
            "primary": false
        },
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "OH",
            "license": "35.147046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aelisa261884@epicdirect.promedica.org",
            "affiliation": "N",
            "address_1": "100 Madison Ave",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436041516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Perrysburg, OH

Sources for this page

Verify at the official NPI Registry.