Individual provider Active NPI

Bonnie J Brahaney, CNP

  • Nurse Practitioner
  • Sylvania, OH
National Provider Identifier
1396005559
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN.199232 Issued in OH
Practice address
5308 Harroun Rd
Suite 055
Sylvania, OH 43560-2114
Phone
(419) 824-6599
Fax
(419) 885-3870
NPI assigned
May 22, 2012
Sex
Female
Sole proprietor
Yes

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
Nurse Practitioner 363L00000X RN.199232 OH Primary

Addresses

Primary practice location

5308 Harroun Rd
Suite 055
Sylvania, OH 43560-2114

Mailing address

1 Seagate Ste 800
Toledo, OH 43604-1558
Phone (419) 824-6599

Other identifiers 1

IdentifierTypeStateIssuer
0068423MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bbrahaney12921@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
I20120723000882 OH Practitioner - Nurse Practitioner 3678739455 Reassigns benefits to 2 organizations
I20180829001165 MI Practitioner - Nurse Practitioner 3678739455 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
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)

2142 N Cove Blvd
Toledo, OH 43606-3895
Phone (419) 291-1111

718 N Macomb St
Monroe, MI 48162-7815
Phone (419) 240-8835

Hospital & facility affiliations

  • Promedica Toledo Hospital Hospital, Toledo, OH, CCN 360068
  • Promedica Defiance Regional Hospital Hospital, Defiance, OH, CCN 361328
  • Promedica Monroe Regional Hospital Hospital, Monroe, MI, CCN 230099
  • Mercy Health - Defiance Hospital Hospital, Defiance, OH, CCN 360270

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN.199232OHMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Toledo Hospital CurrentSince Oct 10, 2024 Accepting new patients
The Toledo Hospital Current Accepting new patients
Haematology-Oncology Associates of Ohio and Michigan PC Current Accepting new patients
Consultants in Laboratory Medicine of Greater Toledo Current Accepting new patients
The Toledo Hospital CurrentSince Oct 10, 2024 Accepting new patients

Locations

718 N Macomb St
#5
Monroe, MI 48162

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

1200 Ralston Ave
Defiance, OH 43512
Phone (419) 783-6944

501 Van Buren St
Fostoria, OH 44830
Phone (419) 435-7734

715 S Taft Ave
Fremont, OH 43420
Phone (419) 332-7321

5308 Harroun Rd
Ste 55
Sylvania, OH 43560
Phone (419) 824-6599

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

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

1091 Pray Blvd
Waterville, OH 43566
Phone (419) 785-3282

Interoperability endpoints

  • Direct secure messaging: bbrahaney12921@direct.promedica.org

Organizations & group practices 7

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 6

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": "1337644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1396005559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SEAGATE STE 800",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436041558",
            "telephone_number": "419-824-6599",
            "fax_number": "419-882-3870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5308 HARROUN RD",
            "address_2": "SUITE 055",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435602114",
            "telephone_number": "419-824-6599",
            "fax_number": "419-885-3870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAHANEY",
        "first_name": "BONNIE",
        "middle_name": "J",
        "credential": "CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-22",
        "last_updated": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "RN.199232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0068423",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bbrahaney12921@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 Sylvania, OH

Sources for this page

Verify at the official NPI Registry.