Individual provider Active NPI

Jacob Kanjuparamban, A.A.

  • Anesthesiologist Assistant
  • Toledo, OH
National Provider Identifier
1356338578
Registry record updated May 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
License
67000106 Issued in OH
Practice address
3000 Arlington Ave
Toledo, OH 43614-2595
Phone
(419) 383-3556
Fax
(419) 383-3550
NPI assigned
Oct 3, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiologist Assistant 367H00000X 67000106 OH Primary

Addresses

Primary practice location

3000 Arlington Ave
Toledo, OH 43614-2595

Mailing address

3355 Glendale Ave FL 3
Toledo, OH 43614-2426
Phone (419) 419-3556

Other identifiers 1

IdentifierTypeStateIssuer
2503588MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040901000623 OH Practitioner - Anesthesiology Assistant 3173598109 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3000 Arlington Ave
Toledo, OH 43614-2595
Phone (419) 383-3578

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.34 of 100Reported as group
Quality
69.17
Promoting interoperability
99
Improvement activities
40
Cost
75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Associate of Arts

State licenses

LicenseStateTypeSpecialty
003161GAMDCounselor
67000106OHMDAnesthesiologist Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Toledo Physicians LLC CurrentSince Jul 1, 2004 Accepting new patients
Medical University of Ohio at Toledo Current Accepting new patients
Advanced Anesthesia Associates, PC Anesthesiologist Assistant Past Accepting new patients
Grady Memorial Hospital Corporation Past Accepting new patients
Grady Memorial Hospital Corporation Past Accepting new patients

Locations

L4189
Columbus, OH 43260

3125 Transverse Dr
Toledo, OH 43614
Phone (419) 383-3771

3000 Arlington Ave
Toledo, OH 43614
Phone (419) 383-3556

3355 Glendale Ave
Toledo, OH 43614
Phone (419) 383-5614

3355 Glendale Ave
Fl 3
Toledo, OH 43614
Phone (419) 383-7100

Interoperability endpoints

  • Direct secure messaging: jkanjuparamban24984@direct.utoledo.edu

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1128297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525824000000",
    "number": "1356338578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3355 GLENDALE AVE FL 3",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436142426",
            "telephone_number": "419-419-3556",
            "fax_number": "419-383-3550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 ARLINGTON AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436142595",
            "telephone_number": "419-383-3556",
            "fax_number": "419-383-3550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANJUPARAMBAN",
        "first_name": "JACOB",
        "name_prefix": "Mr.",
        "credential": "A.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-03",
        "last_updated": "2018-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "OH",
            "license": "67000106",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2503588",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.