Individual provider Active NPI

Jennifer Ann Martinez, CNP

  • Nurse Practitioner
  • Toledo, OH
National Provider Identifier
1356723217
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APRN.CNP.17531 Issued in OH
Practice address
2130 W Central Ave Ste 101
Toledo, OH 43606-3819
Phone
(419) 291-3900
Fax
(419) 479-6055
NPI assigned
Jun 26, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704189540 MI
Nurse Practitioner 363L00000X APRN.CNP.17531 OH Primary

Addresses

Primary practice location

2130 W Central Ave Ste 101
Toledo, OH 43606-3819

Mailing address

2545 Coachlite Dr
Tecumseh, MI 49286-9599
Phone (517) 795-3040

Other practice location 1

777 Kimole Ln # 205
Adrian, MI 49221-1478
Phone (419) 291-3900

Other names 1

  • Jennifer Dickerson Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jdickerson7906@epicdirect.promedica.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, MI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20150723006867 OH Practitioner - Nurse Practitioner 6709199516 Reassigns benefits to 1 organization
I20150727002678 MI Practitioner - Nurse Practitioner 6709199516 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Promedica Multi Specialty PhysiciansGroup PAC ID 7113182809, 269 clinicians

Practice addresses (Care Compare)

2130 W Central Ave
101 102 103
Toledo, OH 43606-3834
Phone (419) 291-3900

777 Kimole LN
Suite 250
Adrian, MI 49221-1400
Phone (419) 291-3900

Hospital & facility affiliations

  • Promedica Charles and Virginia Hickman Hospital Hospital, Adrian, MI, CCN 230005
  • Promedica Toledo Hospital Hospital, Toledo, OH, CCN 360068

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
APRN.CNP.17531OHMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Joseph Mercy Hospital Current Accepting new patients
St Joseph Mercy Hospital CurrentSince Jan 18, 2019 Accepting new patients
St Joseph Mercy Hospital CurrentSince Jan 18, 2019 Accepting new patients
Promedica Multi Specialty Physicians CurrentSince Jan 1, 2026 Accepting new patients

Locations

777 Kimole Ln
Ste 250
Adrian, MI 49221
Phone (517) 265-3411

777 Kimole Ln
Ste 130
Adrian, MI 49221
Phone (517) 265-0292

1600 S Canton Center Rd
Canton, MI 48188
Phone (734) 398-7557

34505 W 12 Mile Rd
Ste 200
Farmington Hills, MI 48331
Phone (734) 343-3922

730 N Macomb St
Ste 319
Monroe, MI 48162
Phone (734) 241-3900

718 N Macomb St
Monroe, MI 48162
Phone (734) 212-3097

5301 McAuley Dr
Ypsilanti, MI 48197
Phone (734) 712-7246

2801 Bay Park Dr
Oregon, OH 43616
Phone (419) 690-7652

2142 N Cove Blvd
Toledo, OH 43606
Phone (419) 291-1111

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

2130 W Central Ave
Ste 101
Toledo, OH 43606

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

Interoperability endpoints

  • Direct secure messaging: jmartinez7906@direct.promedica.org

Organizations & group practices 4

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 3

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": "1435276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1356723217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2545 COACHLITE DR",
            "city": "TECUMSEH",
            "state": "MI",
            "postal_code": "492869599",
            "telephone_number": "517-795-3040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2130 W CENTRAL AVE STE 101",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436063819",
            "telephone_number": "419-291-3900",
            "fax_number": "419-479-6055"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "777 Kimole Ln # 205",
            "address_purpose": "LOCATION",
            "city": "Adrian",
            "state": "MI",
            "postal_code": "492211478",
            "country_code": "US",
            "telephone_number": "419-291-3900",
            "fax_number": "419-479-6055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTINEZ",
        "first_name": "JENNIFER",
        "middle_name": "ANN",
        "credential": "CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-26",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704189540",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "APRN.CNP.17531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jdickerson7906@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": [
        {
            "first_name": "JENNIFER",
            "last_name": "DICKERSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.