NPIMap

Individual provider Active NPI

Patrick J Anderson Jr., PA-C

  • Physician Assistant
  • Toledo, OH
National Provider Identifier
1508852740
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50-001590 Issued in OH
Practice address
2142 N Cove Blvd
5 North Pediatrics
Toledo, OH 43606-3895
Phone
(419) 291-4637
Fax
(419) 479-6012
NPI assigned
Sep 22, 2005
Sex
Male
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 50-001590 OH Primary

Addresses

Primary practice location

2142 N Cove Blvd
5 North Pediatrics
Toledo, OH 43606-3895

Mailing address

2142 N Cove Blvd
5 North Pediatrics
Toledo, OH 43606-3895
Phone (419) 291-4637

Other identifiers 1

IdentifierTypeStateIssuer
P00373668OtherOHRRMC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address panderson21056@epicdirect.promedica.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050315000286 OH Practitioner - Physician Assistant 0244285047 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dermatology Associates IncGroup PAC ID 7113092917, 14 clinicians

Practice addresses (Care Compare)

12780 Roachton Rd
Perrysburg, OH 43551-1350
Phone (419) 872-0777

3141 Central Park W
Toledo, OH 43617-1083
Phone (419) 872-0777

Merit-based Incentive Payment System (MIPS)

Final score
91.2 of 100Reported as group
Quality
82.4
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50-001590OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Toledo Hospital CurrentSince Feb 1, 2017 Accepting new patients
Consultants in Laboratory Medicine of Greater Toledo Current Accepting new patients
The Toledo Hospital CurrentSince Feb 1, 2017 Accepting new patients
Haematology-Oncology Associates of Ohio and Michigan PC Current Accepting new patients
Observation Physicians of Northwest Ohio LLC PastSince Mar 21, 2021 Accepting new patients
Promedica Central Physicians Physician Assistant Past Accepting new patients

Locations

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

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

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

2142 N Cove Blvd
#5N
Toledo, OH 43606
Phone (419) 291-4637

Interoperability endpoints

  • Direct secure messaging: patricka@dermassociates.emadirect.md

Organizations & group practices 8

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": "1127347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1508852740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2142 N COVE BLVD",
            "address_2": "5 NORTH PEDIATRICS",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436063895",
            "telephone_number": "419-291-4637",
            "fax_number": "419-479-6012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2142 N COVE BLVD",
            "address_2": "5 NORTH PEDIATRICS",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436063895",
            "telephone_number": "419-291-4637",
            "fax_number": "419-479-6012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "PATRICK",
        "middle_name": "J",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-22",
        "last_updated": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50-001590",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMC",
            "identifier": "P00373668",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "panderson21056@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.