Individual provider Active NPI

Laura Jo Muller, AGNP-C

  • Gerontology Nurse Practitioner
  • Port Clinton, OH
National Provider Identifier
1295505568
Registry record updated Feb 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
APRN.CNP.0035848 Issued in OH
Practice address
615 Fulton St
Port Clinton, OH 43452-2001
Phone
(419) 732-4028
Fax
(419) 732-4013
NPI assigned
Jan 8, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X APRN.CNP.0035848 OH Primary

Addresses

Primary practice location

615 Fulton St
Port Clinton, OH 43452-2001

Mailing address

615 Fulton St
Port Clinton, OH 43452-2001
Phone (419) 301-4352

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
I20240905002388 OH Practitioner - Nurse Practitioner 7113467168 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3004 Hayes Ave
Sandusky, OH 44870-5321
Phone (419) 609-1112

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
APRN.CNP.0035848OHMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Ohio Medical Specialists, LLC CurrentSince May 26, 2024 Accepting new patients
Northern Ohio Medical Specialists LLC CurrentSince May 26, 2024 Accepting new patients
Northern Ohio Medical Specialists, LLC Past Accepting new patients

Locations

615 Fulton St
Port Clinton, OH 43452
Phone (419) 734-3131

701 Tyler St
Sandusky, OH 44870
Phone (419) 557-6959

3004 Hayes Ave
Sandusky, OH 44870
Phone (419) 625-2841

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.

Hospital & facility affiliations 6

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": "1704672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707609600000",
    "number": "1295505568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 FULTON ST",
            "city": "PORT CLINTON",
            "state": "OH",
            "postal_code": "434522001",
            "telephone_number": "419-301-4352",
            "fax_number": "419-732-4013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 FULTON ST",
            "city": "PORT CLINTON",
            "state": "OH",
            "postal_code": "434522001",
            "telephone_number": "419-732-4028",
            "fax_number": "419-732-4013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLER",
        "first_name": "LAURA",
        "middle_name": "JO",
        "credential": "AGNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-01-08",
        "last_updated": "2024-02-11",
        "certification_date": "2024-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "OH",
            "license": "APRN.CNP.0035848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Clinton, OH

Sources for this page

Verify at the official NPI Registry.