Individual provider Active NPI

Lisa Marciniak

  • Family Nurse Practitioner
  • Toledo, OH
National Provider Identifier
1396252748
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
021694 Issued in OH
Practice address
4925 Jackman Rd
Toledo, OH 43613-3574
Phone
(419) 473-1715
NPI assigned
Jan 8, 2018
Last updated
May 16, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 16, 2025

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 APRN.CNP.021694 OH
Family Nurse Practitioner 363LF0000X 021694 OH Primary

Addresses

Primary practice location

4925 Jackman Rd
Toledo, OH 43613-3574

Mailing address

PO Box 932958
Cleveland, OH 44193-0028

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
I20191216002033 OH Practitioner - Nurse Practitioner 0941634455 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Little Clinic of Ohio LLCGroup PAC ID 7719087584, 212 clinicians

Practice addresses (Care Compare)

1094 N Main St
Bowling Green, OH 43402-1346
Phone (419) 373-6687

199 Graceland Blvd
Columbus, OH 43214-1529
Phone (614) 410-2814

226 E Perkins Ave
Sandusky, OH 44870-4905
Phone (419) 239-2626

27386 Carronade Dr
Perrysburg, OH 43551-3368
Phone (567) 336-4662

7059 Orchard Centre Dr
Holland, OH 43528-7961
Phone (567) 297-4117

8730 Waterville Swanton Rd
Waterville, OH 43566-9726
Phone (419) 878-1049

Merit-based Incentive Payment System (MIPS)

Final score
86.78 of 100Reported as group
Quality
71.59
Promoting interoperability
100
Improvement activities
40
Cost
84.34

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
APRN.CNP.021694OHMDNurse Practitioner
021694OHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Little Clinic of Ohio LLC Family CurrentSince Nov 19, 2019 Accepting new patients

Locations

199 Graceland Blvd
Columbus, OH 43214
Phone (614) 410-2814

4925 Jackman Rd
Toledo, OH 43613
Phone (419) 473-1715

Interoperability endpoints

  • Direct secure messaging: lisa.marciniak@krogerhealth.eclinicaldirectplus.com

Organizations & group practices 1

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1515369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747353600000",
    "number": "1396252748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 932958",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441930028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4925 JACKMAN RD",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436133574",
            "telephone_number": "419-473-1715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARCINIAK",
        "first_name": "LISA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-08",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "APRN.CNP.021694",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "021694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.