Individual provider Active NPI

Michael Fomenky, CNP

  • Family Nurse Practitioner
  • Delaware, OH
National Provider Identifier
1053781575
Registry record updated Sep 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
COA.18158-NP Issued in OH
Practice address
336 W Wind Rd
Delaware, OH 43015-7737
Phone
(000) 000-0000
NPI assigned
Sep 26, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X COA.18158-NP OH Primary

Addresses

Primary practice location

336 W Wind Rd
Delaware, OH 43015-7737

Mailing address

336 W Wind Rd
Delaware, OH 43015-7737
Phone (000) 000-0000

Other practice location 1

1 Wyoming St Ste Se3100B
Dayton, OH 45409-2722
Phone (937) 208-8394

Other practice location 2

9000 N Main St
Englewood, OH 45415-1180
Phone (937) 208-8394

Other practice location 3

3130 N County Road 25A
Troy, OH 45373-1337
Phone (937) 440-4466

Other practice location 4

2400 Miami Valley Dr
Centerville, OH 45459-4774
Phone (937) 208-8394

Other practice location 5

1 Medical Center Dr
Middletown, OH 45005-2584
Phone (513) 974-2111

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
I20160108000576 OH Practitioner - Nurse Practitioner 1850693789 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mvhe IncGroup PAC ID 9537066584, 399 clinicians
Ohiohealth CorporationGroup PAC ID 6305758426, 2,295 clinicians

Practice addresses (Care Compare)

1 Wyoming St
Dayton, OH 45409-2722
Phone (937) 208-8394

1010 Refugee Rd
Pickerington, OH 43147-9653

1030 Refugee Rd
Suite 300
Pickerington, OH 43147-9653
Phone (614) 566-2286

111 S Grant Ave
Columbus, OH 43215-4701

111 S Grant Ave 3Rd FL
Columbus, OH 43215-4701
Phone (614) 566-9184

393 E Town St
Columbus, OH 43215-4799

5100 W Broad St
Columbus, OH 43228-1607
Phone (614) 544-2058

5154 W Braod St
Suite 150
Columbus, OH 43228-1607
Phone (614) 566-0774

Hospital & facility affiliations

  • Grant Medical Center Hospital, Columbus, OH, CCN 360017
  • Atrium Medical Center Hospital, Franklin, OH, CCN 360076
  • Doctors Hospital Hospital, Columbus, OH, CCN 360152

Merit-based Incentive Payment System (MIPS)

Final score
80.04 of 100Reported as group
Quality
58.67
Promoting interoperability
98
Improvement activities
40
Cost
76.46

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
COA.18158-NPOHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ohiohealth Corporation CurrentSince Nov 22, 2015 Accepting new patients
Blanchard Valley Regional Health Center CurrentSince Dec 29, 2022 Accepting new patients
Blanchard Valley Regional Health Center CurrentSince Dec 29, 2022 Accepting new patients
Mvhe Inc CurrentSince Oct 5, 2025 Accepting new patients
Mvhe Inc CurrentSince Oct 5, 2025 Accepting new patients
Ohiohealth Corporation CurrentSince Nov 22, 2015 Accepting new patients
Upper Valley Professional Corporation CurrentSince Oct 5, 2025 Accepting new patients
Blanchard Valley Regional Health Center Current Accepting new patients
Mvhe Inc Past Accepting new patients

Locations

722 N Fairfield Rd
Beavercreek, OH 45434
Phone (937) 208-7000

393 E Town St
Ste 116
Columbus, OH 43215
Phone (614) 566-9108

Dept L3652
Columbus, OH 43260

1 Wyoming St
Ste SE3100B
Dayton, OH 45409
Phone (937) 208-8394

2451 Wayne Ave
Dayton, OH 45420
Phone (937) 252-1831

2400 Miami Valley Dr
Dayton, OH 45459
Phone (937) 208-8394

5400 Frantz Rd
Ste 250
Dublin, OH 43016
Phone (614) 544-6161

9000 N Main St
Englewood, OH 45415
Phone (937) 208-8394

1900 S Main St
Findlay, OH 45840
Phone (419) 423-4500

1 Medical Center Dr
Middletown, OH 45005
Phone (513) 424-2111

5100 W Broad St
New Rome, OH 43228
Phone (614) 544-1000

450 N Hyatt St
Ste 202
Tipp City, OH 45371
Phone (937) 667-3141

3130 N County Road 25A
Troy, OH 45373
Phone (937) 440-4000

Organizations & group practices 9

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 3

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": "1443225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759190400000",
    "number": "1053781575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "336 W WIND RD",
            "city": "DELAWARE",
            "state": "OH",
            "postal_code": "430157737",
            "telephone_number": "000-000-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "336 W WIND RD",
            "city": "DELAWARE",
            "state": "OH",
            "postal_code": "430157737",
            "telephone_number": "000-000-0000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Wyoming St Ste Se3100B",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454092722",
            "country_code": "US",
            "telephone_number": "937-208-8394",
            "fax_number": "937-641-2780",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9000 N Main St",
            "address_purpose": "LOCATION",
            "city": "Englewood",
            "state": "OH",
            "postal_code": "454151180",
            "country_code": "US",
            "telephone_number": "937-208-8394",
            "fax_number": "937-641-2780",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3130 N County Road 25A",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "OH",
            "postal_code": "453731337",
            "country_code": "US",
            "telephone_number": "937-440-4466",
            "fax_number": "937-641-2780",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2400 Miami Valley Dr",
            "address_purpose": "LOCATION",
            "city": "Centerville",
            "state": "OH",
            "postal_code": "454594774",
            "country_code": "US",
            "telephone_number": "937-208-8394",
            "fax_number": "937-641-2780",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Middletown",
            "state": "OH",
            "postal_code": "450052584",
            "country_code": "US",
            "telephone_number": "513-974-2111",
            "fax_number": "937-641-2780",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FOMENKY",
        "first_name": "MICHAEL",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-26",
        "last_updated": "2025-09-30",
        "certification_date": "2025-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "COA.18158-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Delaware, OH

Sources for this page

Verify at the official NPI Registry.