Active NPI
Jay Walter Nielsen, M.D.
- Family Medicine Physician
- Maumee, OH
National Provider Identifier
1982775268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 35-04-0332-N
- Practice address
- 1900 Indian Wood Cir
Suite 100
Maumee, OH 43537-4033 - Phone
- (419) 897-6490
- Fax
- (419) 897-0544
- NPI assigned
- Nov 10, 2006
- Last updated
- Oct 25, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 35-04-0332-N | OH | Primary |
Addresses
Primary practice location
1900 Indian Wood Cir
Suite 100
Maumee, OH 43537-4033
Mailing address
1900 Indian Wood Cir
Suite 100
Maumee, OH 43537-4033
Phone (419) 897-6490
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0419158 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 19, 2017 through Oct 19, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lima Memorial Joint Operating Company | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Spine and Joint Care Inc
- Adult Medicine Physician
- Maumee, OH
- NPI 1972784825
-
dba Lima Memorial Health System
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193270400000",
"number": "1982775268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 INDIAN WOOD CIR",
"address_2": "SUITE 100",
"city": "MAUMEE",
"state": "OH",
"postal_code": "435374033",
"telephone_number": "419-897-6490",
"fax_number": "419-897-0544"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 INDIAN WOOD CIR",
"address_2": "SUITE 100",
"city": "MAUMEE",
"state": "OH",
"postal_code": "435374033",
"telephone_number": "419-897-6490",
"fax_number": "419-897-0544"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIELSEN",
"first_name": "JAY",
"middle_name": "WALTER",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-10",
"last_updated": "2007-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OH",
"license": "35-04-0332-N",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0419158",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Maumee, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.