Individual provider Active NPI

Edmond O'Brien, M.D.

  • Anesthesiology Physician
  • Ann Arbor, MI
National Provider Identifier
1679869085
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
35.136783 Issued in OH
Practice address
1500 East Medical Center Drive
D3236 MPB, SPC 5718
Ann Arbor, MI 48109-5718
Phone
(734) 763-5589
Fax
(734) 763-4208
NPI assigned
Jun 23, 2011
Last updated
Nov 3, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 4301098514 MI
Anesthesiology Physician 207L00000X 35.136783 OH Primary

Addresses

Primary practice location

1500 East Medical Center Drive
D3236 MPB, SPC 5718
Ann Arbor, MI 48109-5718

Mailing address

333 N Summit St FL 7
Toledo, OH 43604-1531
Phone (877) 373-0871

Other practice location 1

2142 N Cove Blvd
Toledo, OH 43606-3895
Phone (419) 291-4491

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address eobrien222615@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
I20190725003123 OH Practitioner - Anesthesiology 3072820562 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Michigan State University College of Human Medicine, 2011
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)

2865 N Reynolds Rd
BLDG a
Toledo, OH 43615-2100
Phone (419) 578-7200

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301098514MIMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Central Physicians CurrentSince Oct 1, 2021 Accepting new patients
Northstar Anesthesia of Ohio LLC Anesthesiology CurrentSince Jun 12, 2019 Accepting new patients
Promedica Central Physicians CurrentSince Oct 1, 2021 Accepting new patients

Locations

1500 E Medical Center Dr
Spc 5718
Ann Arbor, MI 48109
Phone (734) 763-5589

2615 E High St
Springfield, OH 45505
Phone (888) 861-3994

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

2865 N Reynolds Rd
Bldg A
Toledo, OH 43615
Phone (419) 578-4200

333 N Summit St
Fl 7
Toledo, OH 43604
Phone (419) 252-5909

Interoperability endpoints

  • Direct secure messaging: eobrien222615@epicdirect.promedica.org

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 4

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": "1308787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1679869085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 N SUMMIT ST FL 7",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436041531",
            "telephone_number": "877-373-0871",
            "fax_number": "419-885-3921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 EAST MEDICAL CENTER DRIVE",
            "address_2": "D3236 MPB, SPC 5718",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481095718",
            "telephone_number": "734-763-5589",
            "fax_number": "734-763-4208"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2142 N Cove Blvd",
            "address_purpose": "LOCATION",
            "city": "Toledo",
            "state": "OH",
            "postal_code": "436063895",
            "country_code": "US",
            "telephone_number": "419-291-4491",
            "fax_number": "419-479-6905",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "O'BRIEN",
        "first_name": "EDMOND",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-23",
        "last_updated": "2023-11-03",
        "certification_date": "2021-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "4301098514",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OH",
            "license": "35.136783",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "eobrien222615@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 Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.