Individual provider Active NPI

Kendra N Vonderembse, DO

  • Family Medicine Physician
  • Dayton, OH
National Provider Identifier
1093058083
Registry record updated Nov 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
34.012508 Issued in OH
Practice address
425 W Grand Ave Ste 3003
Dayton, OH 45405-4722
Phone
(937) 294-3603
Fax
(937) 294-3612
NPI assigned
Mar 28, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 16, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 34.012508 OH Primary

Addresses

Primary practice location

425 W Grand Ave Ste 3003
Dayton, OH 45405-4722

Mailing address

425 W Grand Ave Ste 3003
Dayton, OH 45405-4722
Phone (937) 294-3603

Other identifiers 1

IdentifierTypeStateIssuer
0190281MedicaidOH

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kvonderembse514277@direct.ketteringhealth.org
FHIR URL https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161109001202 OH Practitioner - Family Practice 0446539761 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Ohio University, College of Osteopathic Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Alliance Physicians IncGroup PAC ID 0840104360, 314 clinicians

Practice addresses (Care Compare)

1625 S Alex Rd
West Carrollton, OH 45449-5404
Phone (937) 865-0534

70 Weller Dr
Suite 100
Tipp City, OH 45371-3306
Phone (937) 677-0400

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Physicians Inc Family Medicine CurrentSince Apr 6, 2020 Accepting new patients
Alliance Physicians Inc Family Medicine CurrentSince Apr 6, 2020 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Kettering Independent Medical Group Inc Family Medicine Past Accepting new patients

Locations

425 W Grand Ave
Ste 3003
Dayton, OH 45405
Phone (937) 226-7890

70 Weller Dr
Ste 100
Tipp City, OH 45371
Phone (937) 667-0400

70 Weller Dr
Tipp City, OH 45371
Phone (937) 298-4417

1625 S Alex Rd
West Carrollton, OH 45449
Phone (937) 865-0534

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.

Hospital & facility affiliations 6

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": "1364428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605484800000",
    "number": "1093058083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 W GRAND AVE STE 3003",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454054722",
            "telephone_number": "937-294-3603",
            "fax_number": "937-294-3612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 W GRAND AVE STE 3003",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454054722",
            "telephone_number": "937-294-3603",
            "fax_number": "937-294-3612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VONDEREMBSE",
        "first_name": "KENDRA",
        "middle_name": "N",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-03-28",
        "last_updated": "2020-11-16",
        "certification_date": "2020-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "34.012508",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0190281",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kvonderembse514277@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "425 W Grand Ave Ste 3003",
            "city": "Dayton",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454054722",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "425 W Grand Ave Ste 3003",
            "city": "Dayton",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454054722",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.