NPIMap

Individual provider Active NPI

Brynn Charlotte Krukemyer, PA-C

  • Procedural Dermatology Physician
  • Perrysburg, OH
National Provider Identifier
1861083008
Registry record updated Jun 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Procedural Dermatology PhysicianTaxonomy code 207NS0135X
License
50.006703 Issued in OH
Practice address
900 W South Boundary St
Perrysburg, OH 43551-5230
Phone
(419) 873-6963
NPI assigned
Jan 31, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Procedural Dermatology Physician 207NS0135X 50.006703 OH Primary

Addresses

Primary practice location

900 W South Boundary St
Perrysburg, OH 43551-5230

Mailing address

506 West St
Genoa, OH 43430
Phone (419) 708-8012

Other identifiers 1

IdentifierTypeStateIssuer
50.006703RXOtherOHSTATE LICENSE

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
I20210226000205 OH Practitioner - Physician Assistant 7517372436 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Skin Care Experts LLCGroup PAC ID 8729475025, 3 clinicians

Practice addresses (Care Compare)

1252 Ralston Ave
Suite 402C
Defiance, OH 43512-1480
Phone (419) 873-6963

900 W S Boundary St
BLDG 9a
Perrysburg, OH 43551-5245
Phone (419) 873-6963

Hospital & facility affiliations

  • Promedica Toledo Hospital Hospital, Toledo, OH, CCN 360068
  • Promedica Defiance Regional Hospital Hospital, Defiance, OH, CCN 361328

Merit-based Incentive Payment System (MIPS)

Final score
90.26 of 100Reported as group
Quality
81.67
Improvement activities
40
Cost
91.97

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50.006703OHMDProcedural Dermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Haematology-Oncology Associates of Ohio and Michigan PC Current Accepting new patients
The Toledo Hospital CurrentSince Jul 29, 2022 Accepting new patients
Consultants in Laboratory Medicine of Greater Toledo Current Accepting new patients
The Toledo Hospital Urgent Care CurrentSince Jul 29, 2022 Accepting new patients

Locations

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

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 3

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": "1612051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686614400000",
    "number": "1861083008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 WEST ST",
            "city": "GENOA",
            "state": "OH",
            "postal_code": "43430",
            "telephone_number": "419-708-8012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 W SOUTH BOUNDARY ST",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435515230",
            "telephone_number": "419-873-6963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUKEMYER",
        "first_name": "BRYNN",
        "middle_name": "CHARLOTTE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-31",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "OH",
            "license": "50.006703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "50.006703RX",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Perrysburg, OH

Sources for this page

Verify at the official NPI Registry.