Individual provider Active NPI

Evan Prielipp, N.P.

  • Nurse Practitioner
  • Toledo, OH
National Provider Identifier
1679028021
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APRN.CNP.019915 Issued in OH
Practice address
2109 Hughes Dr
#920
Toledo, OH 43606-3856
Phone
(419) 479-2650
NPI assigned
Aug 15, 2016
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
Nurse Practitioner 363L00000X APRN.CNP.019915 OH Primary

Addresses

Primary practice location

2109 Hughes Dr
#920
Toledo, OH 43606-3856

Mailing address

4456 286TH St
Toledo, OH 43611-1913
Phone (419) 908-9084

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address eprielipp49440@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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161118000599 OH Practitioner - Nurse Practitioner 8628357407 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Promedica Central PhysiciansGroup PAC ID 2365348190, 785 clinicians

Practice addresses (Care Compare)

2142 N Cove Blvd
Toledo, OH 43606-3895
Phone (419) 291-4000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
APRN.CNP.019915OHMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Central Physicians Nurse Practitioner CurrentSince Mar 1, 2022 Accepting new patients
Promedica Central Physicians CurrentSince Mar 1, 2022 Accepting new patients

Locations

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

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

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

Organizations & group practices 3

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": "1471219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1679028021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4456 286TH ST",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436111913",
            "telephone_number": "419-908-9084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2109 HUGHES DR",
            "address_2": "#920",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436063856",
            "telephone_number": "419-479-2650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIELIPP",
        "first_name": "EVAN",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-15",
        "last_updated": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "APRN.CNP.019915",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "eprielipp49440@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.