Individual provider Active NPI

Brenda M Hartley, MD

  • Pediatrics Physician
  • Sylvania, OH
National Provider Identifier
1760475727
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
35064035 Issued in OH
Practice address
5700 Monroe St Unit 301
Sylvania, OH 43560-2737
Phone
(419) 291-2121
Fax
(419) 479-6017
NPI assigned
Aug 25, 2005
Last updated
Nov 3, 2023By the provider in NPPES
Sex
Female
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
Pediatrics Physician 208000000X 35064035 OH Primary

Addresses

Primary practice location

5700 Monroe St Unit 301
Sylvania, OH 43560-2737

Mailing address

5700 Monroe St Unit 301
Sylvania, OH 43560-2737
Phone (419) 291-2121

Other practice location 1

3922 Woodley Rd
Ste 100
Toledo, OH 43606-1130
Phone (419) 291-2121

Other names 1

  • Brenda M Hartley-Dymarkowski Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bhartley13592@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
I20181218003982 OH Practitioner - Pediatric Medicine 9436391117 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35064035OHMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Central Physicians CurrentSince Dec 5, 2018 Accepting new patients
Promedica Central Physicians CurrentSince Dec 5, 2018 Accepting new patients

Locations

650 Beaver Creek Cir
Ste 130
Maumee, OH 43537
Phone (419) 891-6210

5700 Monroe St
Sylvania, OH 43560
Phone (419) 473-6622

5700 Monroe St
Unit 301
Sylvania, OH 43560
Phone (419) 291-2121

5700 Monroe St
Unit 308
Sylvania, OH 43560
Phone (419) 291-7555

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

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

3922 Woodley Rd
Ste 100
Toledo, OH 43606
Phone (419) 291-2121

7140 Port Sylvania Dr
Ste 150
Toledo, OH 43617
Phone (419) 843-8170

Interoperability endpoints

  • Direct secure messaging: bhartley13592@direct.promedica.org
  • Direct secure messaging: bhartley13592@epicdirect.promedica.org

Organizations & group practices 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1760475727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 MONROE ST UNIT 301",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435602737",
            "telephone_number": "419-291-2121",
            "fax_number": "419-479-6017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5700 MONROE ST UNIT 301",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435602737",
            "telephone_number": "419-291-2121",
            "fax_number": "419-479-6017"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3922 Woodley Rd",
            "address_2": "Ste 100",
            "address_purpose": "LOCATION",
            "city": "Toledo",
            "state": "OH",
            "postal_code": "436061130",
            "country_code": "US",
            "telephone_number": "419-291-2121",
            "fax_number": "419-479-6017",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARTLEY",
        "first_name": "BRENDA",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-25",
        "last_updated": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35064035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bhartley13592@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": [
        {
            "first_name": "BRENDA",
            "last_name": "HARTLEY-DYMARKOWSKI",
            "middle_name": "M",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sylvania, OH

Sources for this page

Verify at the official NPI Registry.