Individual provider Active NPI

Jessica R Grove, CNP

  • Nurse Practitioner
  • Toledo, OH
National Provider Identifier
1407133697
Registry record updated Jul 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
12763 Issued in OH
Practice address
1913 Belvoir Dr
Toledo, OH 43613-2801
Phone
(419) 787-9829
NPI assigned
Nov 16, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2019

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 12763 OH Primary

Addresses

Primary practice location

1913 Belvoir Dr
Toledo, OH 43613-2801

Mailing address

1913 Belvoir Dr
Toledo, OH 43613-2801
Phone (419) 787-9829

Other identifiers 1

IdentifierTypeStateIssuer
0056949MedicaidOH

Other names 1

  • Jessica R Echelberry Former name

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
I20111213000269 OH Practitioner - Nurse Practitioner 2163697590 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12763OHMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Toledo Hospital CurrentSince Oct 31, 2011 Accepting new patients
Consultants in Laboratory Medicine of Greater Toledo Current Accepting new patients
Haematology-Oncology Associates of Ohio and Michigan PC Current Accepting new patients
The Toledo Hospital CurrentSince Oct 31, 2011 Accepting new patients
The Toledo Hospital Current Accepting new patients

Locations

1601 Brigham Dr
Ste 150
Perrysburg, OH 43551
Phone (419) 794-7700

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

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

Interoperability endpoints

  • Direct secure messaging: jgrove12861@direct.promedica.org

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.

NPI Registry JSON

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

{
    "created_epoch": "1321401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562630400000",
    "number": "1407133697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1913 BELVOIR DR",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436132801",
            "telephone_number": "419-787-9829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1913 BELVOIR DR",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436132801",
            "telephone_number": "419-787-9829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROVE",
        "first_name": "JESSICA",
        "middle_name": "R",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-16",
        "last_updated": "2019-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "12763",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0056949",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "ECHELBERRY",
            "middle_name": "R",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.