Individual provider Active NPI

Elisabeth Tuckor, PA-C

  • Physician Assistant
  • Toledo, OH
National Provider Identifier
1902526551
Registry record updated Aug 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2142 N Cove Blvd
Toledo, OH 43606-3895
Phone
(419) 291-1111
NPI assigned
Sep 1, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363A00000X Primary

Addresses

Primary practice location

2142 N Cove Blvd
Toledo, OH 43606-3895

Mailing address

1661 County Rd S
Swanton, OH 43558-9509
Phone (517) 260-2810

Other names 1

  • Elisabeth Betz Former name

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
I20221129001122 OH Practitioner - Physician Assistant 3678941440 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Temple University School of Medicine, 2022
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 450
Toledo, OH 43606-5102
Phone (419) 291-2003

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

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

5200 Harroun Rd
Sylvania, OH 43560-2168
Phone (419) 824-1444

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Central Physicians Single Specialty CurrentSince Nov 1, 2022 Accepting new patients
Promedica Central Physicians CurrentSince Nov 1, 2022 Accepting new patients

Locations

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

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

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 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": "1661990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722470400000",
    "number": "1902526551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1661 COUNTY RD S",
            "city": "SWANTON",
            "state": "OH",
            "postal_code": "435589509",
            "telephone_number": "517-260-2810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2142 N COVE BLVD",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436063895",
            "telephone_number": "419-291-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKOR",
        "first_name": "ELISABETH",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-01",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELISABETH",
            "last_name": "BETZ",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.