Individual provider Active NPI

Marissa Adele Restivo

  • Nurse Practitioner
  • Perrysburg, OH
National Provider Identifier
1689266793
Registry record updated Jan 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APRN.CNP.0030045 Issued in OH
Practice address
1103 Village Square Dr Ste 100
Perrysburg, OH 43551-1762
Phone
(567) 368-3213
NPI assigned
Feb 9, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704322696 MI
Nurse Practitioner 363L00000X APRN.CNP.0030045 OH Primary

Addresses

Primary practice location

1103 Village Square Dr Ste 100
Perrysburg, OH 43551-1762

Mailing address

1103 Village Square Dr Ste 100
Perrysburg, OH 43551-1762

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, PA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20220131001291 MI Practitioner - Nurse Practitioner 8527451350 Reassigns benefits to 2 organizations
I20250917000025 PA Practitioner - Nurse Practitioner 8527451350 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Iha Health Services CorporationGroup PAC ID 2466351440, 1,149 clinicians

Practice addresses (Care Compare)

1065 N Huron River Dr
Ypsilanti, MI 48197-3296

1255 E M
Pinckney, MI 48169-8133
Phone (734) 878-1000

128 Van Buren St
Chelsea, MI 48118-1623
Phone (734) 475-8677

19000 St Joes Pkwy
Livonia, MI 48152-1477

202 W Highland Rd
Howell, MI 48843-1162

2305 Genoa Bus Park Dr
Brighton, MI 48114-7005

23200 Pontiac TRL
South Lyon, MI 48178-1983

4200 Whitehall Dr
Ann Arbor, MI 48105-9694

4400 Highland Rd
Waterford, MI 48328-1222
Phone (248) 618-6000

44428 Woodward Ave
Suite 102
Pontiac, MI 48341-5009
Phone (734) 712-8700

51341 W Huron River Dr
Trinity Health Iha Medical Group Primary Ca
Van Buren Township, MI 48111-2571
Phone (734) 997-0304

5505 S Old US
Brighton, MI 48116-7524

5505 S Old US 23
101 Thimg Lifestyle Medicine Primary Care E
Brighton, MI 48116-7524
Phone (734) 887-7888

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4704322696MIMDNurse Practitioner
APRN.CNP.0030045OHMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Iha Health Services Corporation Current Accepting new patients
Iha Health Service Corporation CurrentSince Sep 5, 2023 Accepting new patients
Iha Health Services Corporation CurrentSince Sep 5, 2023 Accepting new patients
Trinity Health Mid-Atlantic Medical Group CurrentSince Aug 1, 2025 Accepting new patients
Trinity Health Mid-Atlantic Medical Group CurrentSince Aug 1, 2025 Accepting new patients
Trinity Health Mid-Atlantic Medical Group Past Accepting new patients
Trinity Health Mid-Atlantic Medical Group Past Accepting new patients

Locations

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105
Phone (734) 930-7400

2305 Genoa Business Park Dr
Ste 200
Brighton, MI 48114
Phone (810) 494-6840

49650 Cherry Hill Rd
Ste 120
Canton, MI 48187
Phone (734) 398-7800

128 Van Buren St
Chelsea, MI 48118
Phone (734) 475-8677

1255 E M 36
Pinckney, MI 48169
Phone (734) 878-1000

44428 Woodward Ave
Ste 102
Pontiac, MI 48341
Phone (734) 712-8700

1205 Langhorne Newtown Rd
Ste 202
Langhorne, PA 19047
Phone (215) 348-7000

41 University Dr
Ste 300
Newtown, PA 18940
Phone (215) 710-7037

1201 Langhorne Newtown Rd
Penndel, PA 19047
Phone (215) 710-2100

Interoperability endpoints

  • Direct secure messaging: mrestivo2871007@direct.trinity-health.org

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.

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": "1612828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643155200000",
    "number": "1689266793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 VILLAGE SQUARE DR STE 100",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435511762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 VILLAGE SQUARE DR STE 100",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435511762",
            "telephone_number": "567-368-3213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RESTIVO",
        "first_name": "MARISSA",
        "middle_name": "ADELE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-09",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704322696",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "APRN.CNP.0030045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Perrysburg, OH

Sources for this page

Verify at the official NPI Registry.