Marian Gaida Pham, NP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

71010705A Issued in IN

Practice address

3535 Pentagon Blvd
Beavercreek, OH 45431-1705

Phone

(937) 395-6665

Fax

(937) 395-6668

NPI assigned

Dec 30, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Marian Duselis Former name

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in IN, OH2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Premier Health Specialists IncGroup PAC ID 5597708594, 576 clinicians

Kettering Independent Medical Group IncGroup PAC ID 3173710936, 699 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Miami Valley Hospital Hospital, Dayton, OH, CCN 360051

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mpham1003370@direct.ketteringhealth.org
• Direct secure messaging: mduselis@direct.iuhealth.org

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.

• Kettering Independent Medical Group Inc

  • Orthopaedic Surgery Physician
  • Miamisburg, OH
  • NPI 1629387865
  Medicare reassignment Care Compare group NPD
• Premier Health Specialists Inc

  • Internal Medicine Physician
  • Moraine, OH
  • NPI 1194958223
  Medicare reassignment Care Compare group NPD
• Community Physicians of Indiana Inc

  • Family Medicine Physician
  • Indianapolis, IN
  • NPI 1619105244
  Medicare reassignment NPD
• University Surgeons, Inc.

  • Surgery Physician
  • Indianapolis, IN
  • NPI 1316966229
  Medicare reassignment NPD
• Premier Health Specialists Inc

  • Foot & Ankle Surgery Podiatrist
  • Dayton, OH
  • NPI 1902211287
  NPD
• Community Physicians of Indiana Inc

  • Endocrinology, Diabetes & Metabolism Physician
  • Carmel, IN
  • NPI 1992396337
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Miami Valley Hospital

  • General Acute Care Hospital
  • Dayton, OH
  • NPI 1073688354
  Care Compare affiliation

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

{
    "created_epoch": "1609286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773100800000",
    "number": "1124615695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PRESTIGE PL STE 550",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453426115",
            "telephone_number": "937-762-1310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 PENTAGON BLVD",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454311705",
            "telephone_number": "937-395-6665",
            "fax_number": "937-395-6668"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1801 N Senate Blvd Ste 635",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462021212",
            "country_code": "US",
            "telephone_number": "317-963-1400",
            "fax_number": "317-963-1453",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAM",
        "first_name": "MARIAN",
        "middle_name": "GAIDA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-30",
        "last_updated": "2026-03-10",
        "certification_date": "2026-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28191443A",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IN",
            "license": "71010705A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpham1003370@direct.ketteringhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3535 Pentagon Blvd",
            "city": "Beavercreek",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454311705",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "3535 Pentagon Blvd",
            "city": "Beavercreek",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454311705",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mduselis@direct.iuhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1801 N Senate Blvd Ste 635",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462021212",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARIAN",
            "last_name": "DUSELIS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Paul Gregory Peters, MD
• Shawnie M Peters, LPN
• Timothy Francis Peters, D.O.
• Megan Petric
• Lily Pfleiderer
• Alexis Ann Phillips
• Julie Phipps
• Physiotherapy Associates Inc
• Lisa Pierce
• Dylan Pietrantoni

• Gerontology Nurse Practitioner in Beavercreek, OH
• Providers in Beavercreek, OH by specialty
• Gerontology Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.