NPIMap

Individual provider Active NPI

Diane Jennifer Kielmeyer, NP

  • Family Nurse Practitioner
  • Perrysburg, OH
National Provider Identifier
1588040505
Registry record updated Oct 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN.CNP.17792 Issued in OH
Practice address
1103 Village Square Dr
Ste 100
Perrysburg, OH 43551-1783
Phone
(419) 872-3213
Fax
(419) 872-9549
NPI assigned
Jul 31, 2015
Last updated
Oct 12, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN.CNP.17792 OH Primary

Addresses

Primary practice location

1103 Village Square Dr
Ste 100
Perrysburg, OH 43551-1783

Mailing address

1103 Village Square Dr
Ste 100
Perrysburg, OH 43551-1783
Phone (419) 872-3213

Other identifiers 2

IdentifierTypeStateIssuer
0143094MedicaidOH
H415720OtherOHMEDICARE

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
I20150911001171 OH Practitioner - Nurse Practitioner 8820305683 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Health Physicians-North LLCGroup PAC ID 2668522400, 131 clinicians

Practice addresses (Care Compare)

1103 Village Square Dr
Suite 100
Perrysburg, OH 43551-1762
Phone (419) 872-3213

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
APRN.CNP.17792OHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Physicians-North LLC CurrentSince Aug 17, 2015 Accepting new patients
Mercy Health Physicians - North, LLC CurrentSince Aug 17, 2015 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Mercy Health System Northern Past Accepting new patients

Locations

1103 Village Square Dr
Ste 100
Perrysburg, OH 43551
Phone (419) 872-3213

2222 Cherry St
Ste 2300
Toledo, OH 43608
Phone (419) 251-8013

Interoperability endpoints

  • Direct secure messaging: dkielmeyer104456@direct.bsmhealth.org

Organizations & group practices 4

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 7

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": "1438300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728691200000",
    "number": "1588040505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 VILLAGE SQUARE DR",
            "address_2": "STE 100",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435511783",
            "telephone_number": "419-872-3213",
            "fax_number": "419-872-9549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 VILLAGE SQUARE DR",
            "address_2": "STE 100",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435511783",
            "telephone_number": "419-872-3213",
            "fax_number": "419-872-9549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIELMEYER",
        "first_name": "DIANE",
        "middle_name": "JENNIFER",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-31",
        "last_updated": "2024-10-12",
        "certification_date": "2024-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.17792",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0143094",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "H415720",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Perrysburg, OH

Sources for this page

Verify at the official NPI Registry.