Individual provider Active NPI

Deborah Ann Wise, CNS

  • Oncology Clinical Nurse Specialist
  • Kettering, OH
National Provider Identifier
1134340599
Registry record updated Nov 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oncology Clinical Nurse SpecialistTaxonomy code 364SX0200X
License
COA02210NS Issued in OH
Practice address
3700 Southern Blvd Ste 401
Kettering, OH 45429-1226
Phone
(855) 500-2873
Fax
(937) 281-3913
NPI assigned
May 2, 2007
Last updated
Nov 13, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Nurse Specialist 364S00000X COA02210NS OH
Oncology Clinical Nurse Specialist 364SX0200X COA02210NS OH Primary
Oncology Registered Nurse 163WX0200X RN167460 OH

Addresses

Primary practice location

3700 Southern Blvd Ste 401
Kettering, OH 45429-1226

Mailing address

3700 Southern Blvd Ste 401
Kettering, OH 45429-1265
Phone (855) 500-2873

Other identifiers 1

IdentifierTypeStateIssuer
0067949MedicaidOH

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address dwise514139@direct.khnetwork.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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120628000130 OH Practitioner - Certified Clinical Nurse Specialist (CNS) 4789849548 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Clinical Nurse Specialist (CNS)
Education
Wright State University Boonshoft School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kettering Independent Medical Group IncGroup PAC ID 3173710936, 699 clinicians

Practice addresses (Care Compare)

3535 Pentagon Blvd
Beavercreek, OH 45431-1705

3535 Pentagon Park Blvd
Suite 400
Dayton, OH 45431-1705
Phone (937) 490-2264

3700 Southern Blvd
Kettering, OH 45429-1265

4403 Far Hills Ave
Kettering, OH 45429-2405
Phone (937) 433-5309

4441 Far Hills Ave
Kettering, OH 45429-2405
Phone (937) 298-7751

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.34 of 100Reported as group
Quality
63.67
Promoting interoperability
100
Improvement activities
40
Cost
74.14

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN167460OHMDOncology Registered Nurse
COA02210NSOHMDClinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Kettering Independent Medical Group Inc CurrentSince Dec 29, 2022 Accepting new patients

Locations

3700 Southern Blvd
Ste 401
Kettering, OH 45429
Phone (855) 500-2873

4403 Far Hills Ave
Kettering, OH 45429
Phone (937) 395-3910

1 Prestige Pl
Ste 550
Miamisburg, OH 45342
Phone (937) 752-2306

Interoperability endpoints

  • Direct secure messaging: dwise514139@direct.ketteringhealth.org

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605225600000",
    "number": "1134340599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3700 SOUTHERN BLVD STE 401",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454291265",
            "telephone_number": "855-500-2873",
            "fax_number": "937-281-3913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 SOUTHERN BLVD STE 401",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454291226",
            "telephone_number": "855-500-2873",
            "fax_number": "937-281-3913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "DEBORAH",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "CNS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-02",
        "last_updated": "2020-11-13",
        "certification_date": "2020-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": "OH",
            "license": "COA02210NS",
            "primary": false
        },
        {
            "code": "364SX0200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Oncology",
            "state": "OH",
            "license": "COA02210NS",
            "primary": true
        },
        {
            "code": "163WX0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Oncology",
            "state": "OH",
            "license": "RN167460",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0067949",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dwise514139@direct.khnetwork.org",
            "affiliation": "N",
            "address_1": "3700 Southern Blvd Ste 401",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454291226",
            "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": "3700 Southern Blvd Ste 401",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454291226",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kettering, OH

Sources for this page

Verify at the official NPI Registry.