Individual provider Active NPI

Khaled A Yassine, MD

  • Clinical Neurophysiology Physician
  • Toledo, OH
National Provider Identifier
1578547360
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Neurophysiology PhysicianTaxonomy code 2084N0600X
License
35079813 Issued in OH
Practice address
2109 Hughes Dr
Suite 800
Toledo, OH 43606-3856
Phone
(419) 291-3900
NPI assigned
Dec 5, 2005
Last updated
Nov 3, 2023By the provider in NPPES
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
Clinical Neurophysiology Physician 2084N0600X 35079813 OH Primary

Addresses

Primary practice location

2109 Hughes Dr
Suite 800
Toledo, OH 43606-3856

Mailing address

2109 Hughes Dr
Suite 800
Toledo, OH 43606-3856
Phone (419) 291-3900

Other identifiers 1

IdentifierTypeStateIssuer
2261921MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kyassine34488@epicdirect.promedica.org

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051013000651 OH Practitioner - Neurology 0042235541 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
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

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35079813OHMDClinical Neurophysiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Multi Specialty Physicians CurrentSince Jan 1, 2026 Accepting new patients
Tiberiu Avram MD PC Past Accepting new patients

Locations

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

2109 Hughes Dr
#800
Toledo, OH 43606
Phone (419) 291-3388

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

2109 Hughes Dr
Ste 800
Toledo, OH 43606
Phone (419) 291-3388

2130 W Central Ave
Ste 101
Toledo, OH 43606

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

Interoperability endpoints

  • Direct secure messaging: kyassine34488@direct.promedica.org

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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": "1133740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1578547360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2109 HUGHES DR",
            "address_2": "SUITE 800",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436063856",
            "telephone_number": "419-291-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2109 HUGHES DR",
            "address_2": "SUITE 800",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436063856",
            "telephone_number": "419-291-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YASSINE",
        "first_name": "KHALED",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-05",
        "last_updated": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "OH",
            "license": "35079813",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2261921",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kyassine34488@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.