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Individual provider Active NPI Emergency Medicine Physician · Toledo, OH

NPI 1861456964 · NPPES record last updated Dec 24, 2007

Key facts

NPI
1861456964
Entity type
Individual (NPI type 1)
Primary specialty
Emergency Medicine Physician 207P00000X
License
35-07-6648 (OH)
Practice address
2142 N Cove Blvd
Toledo, OH 43606-3895
Phone
(419) 291-4101
NPI assigned
Apr 14, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 16

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.

Medicare Care Compare profile

Specialty
Emergency Medicine
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Toledo Hospital (118 clinicians)
Emergency Physicians of Northwest Ohio, Inc. (102 clinicians)

Practice addresses (Care Compare)

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

718 N Macomb St
Monroe, MI 48162-7815
Phone (734) 240-8400

Hospital & facility affiliations

  • Promedica Toledo Hospital Hospital · Toledo, OH · CCN 360068

Merit-based Incentive Payment System (MIPS)

Final score
99.25 of 100 (group)
Quality
96.55
Improvement activities
40
Cost
89.76

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in OH, MI
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20050512000610 OH Practitioner - Emergency Medicine 5395795512 Reassigns benefits to 4 organizations
I20190904001754 MI Practitioner - Emergency Medicine 5395795512 Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
52584CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Observation Physicians of Northwest Ohio LLC Emergency Medicine Current
since Apr 1, 2021
Accepting new patients
The Toledo Hospital Current
since Nov 1, 2021
Accepting new patients
The Toledo Hospital Current
since Nov 1, 2021
Accepting new patients
The Toledo Hospital Current Accepting new patients
Haematology-Oncology Associates of Ohio and Michigan PC Current Accepting new patients
Consultants in Laboratory Medicine of Greater Toledo Current Accepting new patients
Joint Township District Memorial Hospital Current
since Feb 3, 2018
Accepting new patients
Emergency Physicians of Northwest Ohio Inc. Emergency Medicine Current
since Jul 1, 2002
Accepting new patients
Emergency Physicians of Northwest Ohio, LLC Emergency Medicine Past Accepting new patients
Fostoria Hospital Association Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
JTDM Family Practice LLC Past Accepting new patients

Locations

718 N Macomb St
Monroe, MI 48162
Phone (734) 212-3097

1200 Ralston Ave
Defiance, OH 43512
Phone (419) 783-6944

501 Van Buren St
Fostoria, OH 44830
Phone (419) 435-7734

455 W 4th St
Ste 10
Fostoria, OH 44830
Phone (419) 436-8320

1001 Bellefontaine Ave
Lima, OH 45804
Phone (419) 228-3335

200 Saint Clair Ave
Saint Marys, OH 45885
Phone (419) 394-3387

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

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 35-07-6648 OH Yes

Addresses

Primary practice location

2142 N Cove Blvd
Toledo, OH 43606-3895

Mailing address

6896 W Snowville Rd
Brecksville, OH 44141-3214

Other identifiers

IdentifierTypeStateIssuer
810547599048MedicaidOH
727186OtherOHBCHP
4440955MedicaidMI
341960760032OtherOHCARESOURCE
000000271431OtherOHANTHEM
000000372948OtherOHANTHEM
2222106MedicaidOH

Other providers in Toledo, OH

All providers in Toledo, OH · Emergency Medicine Physician in Ohio

Sources for this page

Verify at the official NPI Registry.