Individual provider Active NPI

Miriam Medhkour, DO

  • Family Medicine Physician
  • Perrysburg, OH
National Provider Identifier
1346653631
Registry record updated Jul 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
34012836 Issued in OH
Practice address
900 W South Boundary St BLDG 9a
Perrysburg, OH 43551
Phone
(567) 368-1700
Fax
(567) 368-1701
NPI assigned
Jun 4, 2014
Last updated
Jul 24, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 34012836 OH Primary

Addresses

Primary practice location

900 W South Boundary St BLDG 9a
Perrysburg, OH 43551

Mailing address

2200 Jefferson Ave FL 5
Toledo, OH 43604-7102

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180806003159 OH Practitioner - Family Practice 2062638208 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Health Physicians-North LLCGroup PAC ID 2668522400, 131 clinicians

Practice addresses (Care Compare)

3851 Navarre Ave
Suite 200
Oregon, OH 43616-3671
Phone (419) 696-8255

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34012836OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Physicians-North LLC Family Medicine CurrentSince Jul 29, 2018 Accepting new patients
Mercy Health Physicians - North, LLC CurrentSince Jul 29, 2018 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

3851 Navarre Ave
Ste 200
Oregon, OH 43616
Phone (419) 691-6781

1103 Village Square Dr
Perrysburg, OH 43551
Phone (419) 861-4022

1103 Village Square Dr
Ste 100
Perrysburg, OH 43551
Phone (419) 872-3213

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

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

Interoperability endpoints

  • Direct secure messaging: mmedhkour468858@direct.bsmhealth.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1401840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532390400000",
    "number": "1346653631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 JEFFERSON AVE FL 5",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436047102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 W SOUTH BOUNDARY ST BLDG 9A",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "43551",
            "telephone_number": "567-368-1700",
            "fax_number": "567-368-1701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDHKOUR",
        "first_name": "MIRIAM",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-04",
        "last_updated": "2018-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "34012836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Perrysburg, OH

Sources for this page

Verify at the official NPI Registry.