NPIMap

Individual provider Active NPI

Krystal L Brill, PA-C

  • Physician Assistant
  • Wapakoneta, OH
National Provider Identifier
1346581360
Registry record updated Dec 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.005073RX Issued in OH
Practice address
602 W Redskin TRL
Wapakoneta, OH 45895-9349
Phone
(419) 738-5151
Fax
(419) 941-1092
NPI assigned
Mar 15, 2013
Last updated
Dec 29, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50.005073RX OH Primary

Addresses

Primary practice location

602 W Redskin TRL
Wapakoneta, OH 45895-9349

Mailing address

1001 Bellefontaine Ave
Lima, OH 45804-2800
Phone (419) 998-4575

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address krystal.woolley@lmpc.eclinicaldirectplus.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170921000455 OH Practitioner - Physician Assistant 1052558731 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1001 Bellefontaine Ave
Lima, OH 45804-2800
Phone (419) 998-4575

602 W Redskin TRL
Wapakoneta, OH 45895-9349
Phone (419) 738-5151

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lima Memorial Professional Corporation CurrentSince Aug 28, 2017 Accepting new patients
Lima Memorial Professional Corporation CurrentSince Aug 28, 2017 Accepting new patients
Lima Memorial Professional Corporation Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Lima Memorial Professional Corporation Past Accepting new patients

Locations

L3982
Columbus, OH 43260

1001 Bellefontaine Ave
Lima, OH 45804
Phone (419) 228-3335

1005 Bellefontaine Ave
Ste 340
Lima, OH 45804
Phone (419) 222-8432

602 W Redskin Trl
Wapakoneta, OH 45895
Phone (419) 738-5151

Interoperability endpoints

  • Direct secure messaging: krystal.woolley@lmpc.eclinicaldirectplus.com

Organizations & group practices 5

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 4

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": "1363305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609200000000",
    "number": "1346581360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 BELLEFONTAINE AVE",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458042800",
            "telephone_number": "419-998-4575",
            "fax_number": "419-998-4586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 W REDSKIN TRL",
            "city": "WAPAKONETA",
            "state": "OH",
            "postal_code": "458959349",
            "telephone_number": "419-738-5151",
            "fax_number": "419-941-1092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRILL",
        "first_name": "KRYSTAL",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-15",
        "last_updated": "2020-12-29",
        "certification_date": "2020-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.005073RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krystal.woolley@lmpc.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "602 W Redskin Trl",
            "city": "Wapakoneta",
            "state": "OH",
            "country_code": "US",
            "postal_code": "458959349",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wapakoneta, OH

Sources for this page

Verify at the official NPI Registry.