NPIMap

Individual provider Active NPI

Mark R Bruss, M.D.

  • Family Medicine Physician
  • Waterville, OH
National Provider Identifier
1720082423
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35038690-B Issued in OH
Practice address
900 Waterville Monclova Rd
Ste a
Waterville, OH 43566-1169
Phone
(419) 878-2026
Fax
(419) 878-3236
NPI assigned
Jun 9, 2005
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35038690-B OH Primary

Addresses

Primary practice location

900 Waterville Monclova Rd
Ste a
Waterville, OH 43566-1169

Mailing address

900 Waterville Monclova Rd
Ste a
Waterville, OH 43566-1169
Phone (419) 878-2026

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
I20051024000014 OH Practitioner - Family Practice 5698748630 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Toledo College of Medicine, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Health Physicians-North LLCGroup PAC ID 2668522400, 131 clinicians

Practice addresses (Care Compare)

2213 Cherry St
Toledo, OH 43608-2603

2222 Cherry St
Toledo, OH 43608-2675

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35038690-BOHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Anne Grady Corporation CurrentSince Jan 1, 1993 Accepting new patients
Mercy Health Physicians-North LLC Family Medicine CurrentSince May 31, 2023 Accepting new patients
Anne Grady Corporation CurrentSince Jan 1, 1993 Accepting new patients
Mercy Health Physicians - North, LLC CurrentSince May 31, 2023 Accepting new patients
Geneva Opco LLC Past Accepting new patients

Locations

1525 Eber Rd
Holland, OH 43528
Phone (419) 866-6500

5901 Monclova Rd
Maumee, OH 43537
Phone (419) 893-5911

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

Interoperability endpoints

  • Direct secure messaging: mbruss1862167@direct.bsmhealth.org

Organizations & group practices 6

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 9

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": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720082423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 WATERVILLE MONCLOVA RD",
            "address_2": "STE A",
            "city": "WATERVILLE",
            "state": "OH",
            "postal_code": "435661169",
            "telephone_number": "419-878-2026",
            "fax_number": "419-878-3236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 WATERVILLE MONCLOVA RD",
            "address_2": "STE A",
            "city": "WATERVILLE",
            "state": "OH",
            "postal_code": "435661169",
            "telephone_number": "419-878-2026",
            "fax_number": "419-878-3236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUSS",
        "first_name": "MARK",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35038690-B",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterville, OH

Sources for this page

Verify at the official NPI Registry.