Individual provider Active NPI

Samantha J Ticchi-Junkins, PA-C

  • Surgical Physician Assistant
  • Toledo, OH
National Provider Identifier
1790004596
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
50-003056 Issued in OH
Practice address
2109 Hughes Dr
220
Toledo, OH 43606-3856
Phone
(419) 291-5150
Fax
(419) 479-6173
NPI assigned
May 19, 2010
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
Surgical Physician Assistant 363AS0400X 50-003056 OH Primary

Addresses

Primary practice location

2109 Hughes Dr
220
Toledo, OH 43606-3856

Mailing address

2109 Hughes Dr
220
Toledo, OH 43606-3856
Phone (419) 291-5150

Other identifiers 1

IdentifierTypeStateIssuer
0074294MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sticchijunkins7558@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
I20100621000334 OH Practitioner - Physician Assistant 6709916695 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
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)

2109 Hughes Dr
Suite 220
Toledo, OH 43606-5121
Phone (419) 291-5150

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

2901 N Reynolds Rd
Toledo, OH 43606
Phone (419) 578-7700

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
50-003056OHMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Consultants in Laboratory Medicine of Greater Toledo Current Accepting new patients
Promedica Central Physicians CurrentSince Jun 1, 2016 Accepting new patients
Promedica Central Physicians CurrentSince Jun 1, 2016 Accepting new patients
Haematology-Oncology Associates of Ohio and Michigan PC Current Accepting new patients
The Toledo Hospital CurrentSince May 13, 2019 Accepting new patients
The Toledo Hospital CurrentSince May 13, 2019 Accepting new patients
Erie Emergency Physicians, Inc. Past Accepting new patients

Locations

2751 Bay Park Dr
Ste 202
Oregon, OH 43616
Phone (419) 690-7550

2751 Bay Park Dr
Ste 303
Oregon, OH 43616
Phone (419) 690-7676

2600 Navarre Ave
Oregon, OH 43616
Phone (419) 696-7200

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

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

1 Seagate
#800
Toledo, OH 43604
Phone (567) 585-1964

2109 Hughes Dr
#220
Toledo, OH 43606
Phone (419) 291-5150

2109 Hughes Dr
Ste 220
Toledo, OH 43606
Phone (419) 291-5150

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

Interoperability endpoints

  • Direct secure messaging: sticchijunkins7558@direct.promedica.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": "1274227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1790004596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2109 HUGHES DR",
            "address_2": "220",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436063856",
            "telephone_number": "419-291-5150",
            "fax_number": "419-479-6173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2109 HUGHES DR",
            "address_2": "220",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436063856",
            "telephone_number": "419-291-5150",
            "fax_number": "419-479-6173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TICCHI-JUNKINS",
        "first_name": "SAMANTHA",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-19",
        "last_updated": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OH",
            "license": "50-003056",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0074294",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sticchijunkins7558@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.