KETTERING INDEPENDENT MEDICAL GROUP, INC. (NPI# 1629387865) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629387865 |
| Entity Type | Organization |
| Organization Name | KETTERING INDEPENDENT MEDICAL GROUP, INC. |
| Other Organization Name | KETTERING SPECIALTY CARE, INC. |
| Practice Address |
1 Prestige Pl Suite 910 Miamisburg OH 45342-3794 |
| Mailing Address |
1 Prestige Pl Suite 550 Miamisburg OH 45342-3794 |
| Practice Telephone | 9377621629 |
| Mailing Telephone | 9377621306 |
| Mailing Fax Number | 9375227626 |
| Enumeration Date | 2010-10-06 |
| Last Update Date | 2017-02-23 |
| Authorized Official Name | TIMOTHY Y KO (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 9375883208 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Kettering Specialty Care, Inc. | Former Legal Business Name - Organization |
| Street Address |
1 PRESTIGE PL SUITE 910 |
| City | MIAMISBURG |
| State | OH |
| Zip Code | 45342-3794 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205464229 | Cameron Holicki | Student in an Organized Health Care Education/Training Program | Sycamore Primary Care Center 2115 Leiter Road, Miamisburg, OH 45342 | 2020-03-27 |
| 1699315663 | Heather Ann Garrett | Behavior Technician | 9260 Marketplace Drive, Miamisburg, OH 45342 | 2020-01-08 |
| 1770046443 | Makayla Rottet | Occupational Therapist | 10500 Innovation Way #320, Miamisburg, OH 45342 | 2019-04-10 |
| 1932662780 | David Chi | Student in an Organized Health Care Education/Training Program | 2115 Leiter Road, Miamisburg, OH 45342 | 2019-04-09 |
| 1508339557 | John R Striebel Dds Inc | Dentist | 9200 Marketplace Drive, Miamisburg, OH 45342 | 2019-01-02 |
| 1801382320 | Laura Maag | Nurse Practitioner | 415 Byers Rd Ste 300, Miamisburg, OH 45342 | 2018-07-09 |
| 1659862761 | Orion Sports Medicine LLC | Physical Therapist | 2042 Byers Rd, Miamisburg, OH 45342 | 2018-05-24 |
| 1982101879 | Avneek Singh Sandhu | Student in an Organized Health Care Education/Training Program | Sycamore Primary Care Center, 2115 Leiter Road, Miamisburg, OH 45342 | 2018-04-09 |
| 1700386125 | Daniel Hendricks | Nurse Practitioner | 4000 Miamisburg Centerville Rd Ste 405, Miamisburg, OH 45342 | 2018-02-13 |
| 1639692015 | Delsean Porter | Behavior Technician | 2750 Technical Dr, Miamisburg, OH 45342 | 2017-07-18 |
| Find all providers in zip 45342 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164855672 | Total Health & Wellness Obgyn LLC | Obstetrics & Gynecology | 4000 Miamisburg Centerville Rd, Suite 104, Miamisburg, OH 45342-7615 | 2013-08-20 |
| 1841576006 | Greene Memorial Hospital Services, Inc | Obstetrics & Gynecology | 4000 Miamisburg Centerville Rd, Suit 200, Miamisburg, OH 45342-7615 | 2011-11-01 |
| 1134125123 | Rosalind J Jackson | Obstetrics & Gynecology | 4000 Miamisburg Centerville Rd, Ste. 200, Miamisburg, OH 45342-7615 | 2005-06-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952917973 | Complete Care for Women | Obstetrics & Gynecology | 99 North Brice Rd, Suite 320, Columbus, OH 43213 | 2020-09-16 |
| 1366086761 | Women's Integrative Medicine Obgyn LLC | Obstetrics & Gynecology | 477 Cooper Rd Ste 320, Westerville, OH 43081-6045 | 2019-10-30 |
| 1700437266 | Obstetrics and Gynecology South, Inc | Obstetrics & Gynecology | 700 S Stanfield Rd Ste B, Troy, OH 45373-2569 | 2019-09-26 |
| 1407414386 | Ronald James Thompson Md | Obstetrics & Gynecology | 2200 Victory Pkwy Apt 1602, Cincinnati, OH 45206-2824 | 2019-06-05 |
| 1043876394 | Rachel K Booth | Obstetrics & Gynecology | 128 E Apple St Ste 3800d, Dayton, OH 45409-2902 | 2019-05-13 |
| 1871060608 | Ahmed Shahata | Obstetrics & Gynecology | Ashtabula County Medical Center/obgyn Dept, 2420 Lake Ave, Ashtabula, OH 44004 | 2018-10-30 |
| 1992204432 | Catherine Nowak | Obstetrics & Gynecology | 1611 S Green Rd Ste 238, South Euclid, OH 44121-4123 | 2018-02-11 |
| 1649786963 | Columbus Obstetric and Gynecology Center | Obstetrics & Gynecology | 340 E Town St Ste 8900, Columbus, OH 43215-4646 | 2017-12-22 |
| 1538673090 | Healthy Beginnings Inc | Obstetrics & Gynecology | 1230 W Kemper Rd, Cincinnati, OH 45240-1618 | 2017-11-20 |
| 1568989762 | Women's Health for Life, Inc. | Obstetrics & Gynecology | 1220 E Elm St Ste 204, Lima, OH 45804-2898 | 2017-08-28 |
| Find all providers with the same taxonomy | ||||
| City | MIAMISBURG |
| Zip Code | 45342 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.