Individual provider Active NPI

Theresa Lynn Musgrave, PA-C

  • Physician Assistant
  • Toledo, OH
National Provider Identifier
1356651558
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.003101 Issued in OH
Practice address
2865 N Reynolds Rd BLDG a
Toledo, OH 43615-2100
Phone
(419) 578-7200
Fax
(419) 537-5600
NPI assigned
Oct 21, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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 50.003101 OH Primary

Addresses

Primary practice location

2865 N Reynolds Rd BLDG a
Toledo, OH 43615-2100

Mailing address

333 N Summit St FL 7
Toledo, OH 43604-1531
Phone (419) 578-7200

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tmusgrave28269@epicdirect.promedica.org

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
I20101203000408 OH Practitioner - Physician Assistant 3476740432 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Promedica Central PhysiciansGroup PAC ID 2365348190, 785 clinicians

Practice addresses (Care Compare)

2109 Hughes Dr
Suite 450
Toledo, OH 43606-5102
Phone (419) 291-2003

2142 N Cove Blvd
Toledo, OH 43606-3895
Phone (419) 291-4000

2865 N Reynolds Rd
BLDG a
Toledo, OH 43615-2100
Phone (419) 578-7200

2901 N Reynolds Rd
Toledo, OH 43606
Phone (419) 578-7700

5200 Harroun Rd
Sylvania, OH 43560-2168
Phone (419) 824-1444

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50.003101OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Central Physicians CurrentSince Jan 1, 2021 Accepting new patients
Promedica Central Physicians Physician Assistant CurrentSince Jan 1, 2021 Accepting new patients

Locations

2865 N Reynolds Rd
Ste 190
Toledo, OH 43615
Phone (419) 578-7500

333 N Summit St
Fl 7
Toledo, OH 43604
Phone (419) 252-5909

100 Madison Ave
Toledo, OH 43604
Phone (567) 585-1964

4235 Secor Rd
Toledo, OH 43623
Phone (419) 214-4214

2109 Hughes Dr
Ste 450
Toledo, OH 43606
Phone (419) 251-3112

2865 N Reynolds Rd
Bldg A
Toledo, OH 43615
Phone (419) 578-4200

Interoperability endpoints

  • Direct secure messaging: tmusgrave28269@direct.promedica.org

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.

Hospital & facility affiliations 2

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": "1287619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1356651558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 N SUMMIT ST FL 7",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436041531",
            "telephone_number": "419-578-7200",
            "fax_number": "419-537-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2865 N REYNOLDS RD BLDG A",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436152100",
            "telephone_number": "419-578-7200",
            "fax_number": "419-537-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUSGRAVE",
        "first_name": "THERESA",
        "middle_name": "LYNN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-21",
        "last_updated": "2023-11-03",
        "certification_date": "2020-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.003101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tmusgrave28269@epicdirect.promedica.org",
            "affiliation": "N",
            "address_1": "100 Madison Ave",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436041516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.