Active NPI
Jennifer Haselman
- Nurse Practitioner
- Sylvania, OH
National Provider Identifier
1255715231
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- COA17566NP
- Practice address
- 5300 Harroun Rd
Suite 304
Sylvania, OH 43560-2182 - Phone
- (419) 824-1100
- Fax
- (419) 824-1771
- NPI assigned
- Jul 20, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | COA17566NP | OH | Primary |
Addresses
Primary practice location
5300 Harroun Rd
Suite 304
Sylvania, OH 43560-2182
Mailing address
5300 Harroun Rd
Suite 304
Sylvania, OH 43560-2182
Phone (419) 824-1100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0140351 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| COA17566NP | OH | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wilmington Treatment Center, LLC | Current | Accepting new patients | |
| Lima Memorial Joint Operating Company | Past | Accepting new patients |
Interoperability endpoints
- jennifer.haselman.1@14940.direct.athenahealth.com
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.
-
- Addiction Medicine (Internal Medicine) Physician
- Wilmington, NC
- NPI 1588151294
-
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1437350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1509321600000",
"number": "1255715231",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5300 HARROUN RD",
"address_2": "SUITE 304",
"city": "SYLVANIA",
"state": "OH",
"postal_code": "435602182",
"telephone_number": "419-824-1100",
"fax_number": "419-824-1771"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5300 HARROUN RD",
"address_2": "SUITE 304",
"city": "SYLVANIA",
"state": "OH",
"postal_code": "435602182",
"telephone_number": "419-824-1100",
"fax_number": "419-824-1771"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HASELMAN",
"first_name": "JENNIFER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-07-20",
"last_updated": "2017-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "OH",
"license": "COA17566NP",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0140351",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sylvania, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.