NPIMap

Organization Active NPI

Promedica Central Physicians

Doing business as ProMedica Physicians Podiatry

  • Durable Medical Equipment & Medical Supplies
  • Sylvania, OH
National Provider Identifier
1932595428
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
PROMEDICA CENTRAL PHYSICIANS
Doing business as
ProMedica Physicians Podiatry
Practice address
5300 Harroun Rd Ste 201
Sylvania, OH 43560-2146
Phone
(419) 885-5563
Fax
(419) 885-5439
NPI assigned
Apr 10, 2015
Last updated
Jul 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Authorized official

Name
Lorraine McCune
Title
Credentialing Specialist
Phone
(567) 585-1964

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary
Foot & Ankle Surgery Podiatrist 213ES0103X OH

Addresses

Primary practice location

5300 Harroun Rd Ste 201
Sylvania, OH 43560-2146

Mailing address

100 Madison Ave # S38805
Toledo, OH 43604-1516

Other identifiers 1

IdentifierTypeStateIssuer
4036950014OtherOHDME

Other names 1

  • ProMedica Physicians Podiatry Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150728006407 OH DME Supplier - Physician - Podiatry 2365348190 Practice locations: Sylvania, OH

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Promedica Central Physicians LLC75 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 17

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 17

Locations

100 Madison Ave
#S38805
Toledo, OH 43604

NPI Registry JSON

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

{
    "created_epoch": "1428624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721001600000",
    "number": "1932595428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MADISON AVE # S38805",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436041516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 HARROUN RD STE 201",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435602146",
            "telephone_number": "419-885-5563",
            "fax_number": "419-885-5439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMEDICA CENTRAL PHYSICIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-10",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A",
        "authorized_official_last_name": "MCCUNE",
        "authorized_official_first_name": "LORRAINE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "567-585-1964"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "OH",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME",
            "identifier": "4036950014",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ProMedica Physicians Podiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sylvania, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.