KETTERING RADIOLOGIST IMAGING CENTER (NPI# 1720037534) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720037534 |
| Entity Type | Organization |
| Organization Name | KETTERING RADIOLOGIST IMAGING CENTER |
| Practice Address |
540 Lincoln Park Blvd Suite 100 Kettering OH 45429-6401 |
| Mailing Address |
Po Box 713082 Columbus OH 43271-3082 |
| Practice Telephone | 9374397861 |
| Mailing Telephone | 6144305707 |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2008-04-20 |
| Authorized Official Name | RONALD J FADELL (PRESIDENT) |
| Authorized Official Telephone | 9374397861 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 0604144 | 05 | |
| ANTHEM | 000000018662 | 01 | |
| MEDICARE RAILROAD | CK1062 | 01 |
| Street Address |
540 LINCOLN PARK BLVD SUITE 100 |
| City | KETTERING |
| State | OH |
| Zip Code | 45429-6401 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215933387 | Reginald Sequeira | Internal Medicine | 540 Lincoln Park Blvd, Suite 200, Kettering, OH 45429-6401 | 2005-06-23 |
| 1801312616 | Denisa Despina Jacobs | Radiologic Technologist | 540 Lincoln Park Blvd, Kettering, OH 45429-6401 | 2017-08-15 |
| 1356364145 | John Lynch IIi | Internal Medicine | 540 Lincoln Park Blvd, Suite 200, Kettering, OH 45429-6401 | 2006-07-25 |
| 1558383141 | Connie Sue Bain | Physical Therapist | 540 Lincoln Park Blvd, Suite 350, Kettering, OH 45429-6401 | 2006-07-24 |
| 1417976192 | Robert Matthew Lemming | Radiology | 540 Lincoln Park Blvd, Suite 100, Kettering, OH 45429-6401 | 2006-07-19 |
| 1275552952 | Sharal Mall | Radiology | 540 Lincoln Park Blvd, Suite 100, Kettering, OH 45429-6401 | 2006-07-19 |
| 1811946932 | Gilbert W. Templeton | Internal Medicine | 540 Lincoln Park Blvd, Suite 200, Kettering, OH 45429-6401 | 2006-05-08 |
| 1356399489 | Premier Integrated Medical Assoc. Ltd. | Physical Therapist | 540 Lincoln Park Blvd, Suite350, Kettering, OH 45429-6401 | 2006-05-04 |
| 1750349551 | Premier Integrated Medical Assoc Ltd | Internal Medicine | 540 Lincoln Park Blvd, Suite 200, Kettering, OH 45429-6401 | 2006-05-02 |
| 1417915224 | Premier Integrated Medical Assoc Ltd | Internal Medicine | 540 Lincoln Park Blvd, Suite 390, Kettering, OH 45429-6401 | 2006-05-02 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821576414 | Lauren Danielle Sivley | Nurse Practitioner | 3535 Sourthern Boulevard, Kettering, OH 45429 | 2018-08-06 |
| 1114446127 | Louai Al-samkari | Chiropractor | 1441 E. Stroop Rd., Kettering, OH 45429 | 2017-09-12 |
| 1407373756 | Benjamin Edward Adkins | Specialist/Technologist | 4116 Vinita Dr., Kettering, OH 45429 | 2017-08-28 |
| 1972036341 | James Kim | Student in an Organized Health Care Education/Training Program | 3535 Southern Boulevard, Kettering, OH 45429 | 2017-04-04 |
| 1023549847 | Adrienne Krysiak | Emergency Medicine | 3525 Southern Boulevard, Kettering, OH 45429 | 2017-03-23 |
| 1386021889 | Cassandra Mckoy | Counselor | 529 East Stroop Road, Kettering, OH 45429 | 2015-05-04 |
| 1417343088 | Candace Benoit | Obstetrics & Gynecology | 3533 Southern Blvd Ste 4600, Dayton, OH 45429 | 2015-04-10 |
| 1275933574 | Lee Schwieterman | Nurse Practitioner | 3535 Southern Blvd., 1 East, Kettering, OH 45429 | 2014-08-25 |
| 1497161947 | Robert Jonathon Fresch Jr. | Obstetrics & Gynecology | 3533 Southern Blvd Ste 3750, Kettering, OH 45429 | 2014-07-05 |
| 1821349812 | Lucas Brewer | Counselor | 1524 E Stroop Rd Ste 300, Kettering, OH 45429 | 2012-10-01 |
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| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134147358 | Jeffery L Nielson | Radiology | 1563 E Dorothy Ln, Kettering, OH 45429-3897 | 2006-07-17 |
| 1487641585 | First Dayton Radiation Oncology Inc | Radiology | 2632 Woodman Center Ct, Kettering, OH 45420-1477 | 2005-10-04 |
| 1730699109 | Samantha Kilia Trout | Radiology | 3535 Southern Blvd, Kettering, OH 45429-1221 | 2017-10-11 |
| 1407243926 | Katherine Elizabeth Abraham | Radiology | 3535 Southern Blvd, Kettering, OH 45429-1298 | 2015-04-22 |
| 1780003517 | Candace R. Potter | Radiology | 3535 Southern Blvd, Kettering, OH 45429 | 2014-04-09 |
| 1770849556 | Courtney Joel Frey | Radiology | 3535 Southern Blvd, Kettering, OH 45429-1221 | 2012-04-06 |
| 1891086286 | Nicholas David Romano | Radiology | 3535 Southern Blvd, Kettering, OH 45429-1221 | 2011-04-20 |
| 1427378256 | Mary Elizabeth Mccrate | Radiology | 3535 Southern Blvd, Kettering, OH 45429-1221 | 2010-06-03 |
| 1740411321 | Brian F. Imbrogno | Radiology | 3535 Southern Blvd, Kettering, OH 45429-1221 | 2009-07-31 |
| 1861588485 | Richard M Klein | Radiology | 3535 Southern Blvd, Kettering, OH 45429-1228 | 2006-10-04 |
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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.