Individual provider Active NPI

Kelleen Porter, DPT

  • Physical Therapist
  • Delaware, OH
National Provider Identifier
1073009163
Registry record updated Dec 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
1871 W William St
Delaware, OH 43015-2255
Phone
(740) 363-4373
Fax
(740) 363-9560
NPI assigned
Jul 2, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

1871 W William St
Delaware, OH 43015-2255

Mailing address

1871 W William St
Delaware, OH 43015-2255
Phone (740) 363-4373

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181005001653 OH Practitioner - Physical Therapist in Private Practice 9638421456 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Foot and Ankle Wellness CenterGroup PAC ID 5395779458, 5 clinicians

Practice addresses (Care Compare)

1871 W William St
Delaware, OH 43015-2255
Phone (740) 363-4373

Merit-based Incentive Payment System (MIPS)

Final score
77.84 of 100Reported as group
Quality
63.13
Improvement activities
40
Cost
75.28

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Foot & Ankle Wellness Center CurrentSince Aug 1, 2019 Accepting new patients
PT Link LLC Physical Therapist CurrentSince Sep 1, 2018 Accepting new patients
Regional Occupational Health Clinics, LLC CurrentSince Feb 1, 2019 Accepting new patients
Grady Memorial Hospital PastSince Aug 1, 2019 Accepting new patients

Locations

1871 W William St
Delaware, OH 43015
Phone (740) 363-4373

7617 Dayton Springfield Rd
Fairborn, OH 45324
Phone (937) 340-6063

1835 E High St
Ste 2
Springfield, OH 45505
Phone (937) 322-8977

4210 W Sylvania Ave
Ste 102
Toledo, OH 43623
Phone (419) 350-3347

4349 Talmadge Rd
Toledo, OH 43623
Phone (419) 654-8818

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1530489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703030400000",
    "number": "1073009163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1871 W WILLIAM ST",
            "city": "DELAWARE",
            "state": "OH",
            "postal_code": "430152255",
            "telephone_number": "740-363-4373",
            "fax_number": "740-363-9560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1871 W WILLIAM ST",
            "city": "DELAWARE",
            "state": "OH",
            "postal_code": "430152255",
            "telephone_number": "740-363-4373",
            "fax_number": "740-363-9560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "KELLEEN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-02",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Delaware, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.