Individual provider Active NPI

Stephanie Maus Ruddy, D.O.

  • Cardiovascular Disease Physician
  • Dayton, OH
National Provider Identifier
1154676542
Registry record updated Apr 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
34.012093 Issued in OH
Practice address
4160 Little York Rd Ste 20
Dayton, OH 45414-5803
Phone
(937) 454-9527
Fax
(937) 454-9532
NPI assigned
Jul 20, 2012
Last updated
Apr 12, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Cardiovascular Disease Physician 207RC0000X 34.012093 OH Primary

Addresses

Primary practice location

4160 Little York Rd Ste 20
Dayton, OH 45414-5803

Mailing address

4160 Little York Rd Ste 20
Dayton, OH 45414-5803
Phone (937) 454-9527

Other identifiers 1

IdentifierTypeStateIssuer
0315554MedicaidOH

Other names 1

  • Dr. Stephanie Marie Maus Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address sruddy509945@direct.ketteringhealth.org
FHIR URL https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/

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
I20181030001688 OH Practitioner - Cardiovascular Disease (Cardiology) 5597903328 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Other, 2012
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)

1380 E Stroop Rd
Kettering, OH 45429-4926
Phone (937) 293-3486

3535 Pentagon Blvd
Beavercreek, OH 45431-1705

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

3535 Southern Blvd
Kettering, OH 45429-1221
Phone (937) 395-8646

4160 Little York Rd
Suite 20
Dayton, OH 45414-5803
Phone (937) 454-9527

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

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

600 W Main St
Troy, OH 45373-3384

7677 Yankee St
Suite 140
Dayton, OH 45459-3475
Phone (866) 224-9472

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
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
34.012093OHMDCardiovascular Disease Physician

Practice roles

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

Locations

4160 Little York Rd
Ste 20
Dayton, OH 45414
Phone (937) 454-9327

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

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

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": "1342742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649721600000",
    "number": "1154676542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4160 LITTLE YORK RD STE 20",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454145803",
            "telephone_number": "937-454-9527",
            "fax_number": "937-454-9532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4160 LITTLE YORK RD STE 20",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454145803",
            "telephone_number": "937-454-9527",
            "fax_number": "937-454-9532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDDY",
        "first_name": "STEPHANIE",
        "middle_name": "MAUS",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-20",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OH",
            "license": "34.012093",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0315554",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sruddy509945@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "4160 Little York Rd Ste 20",
            "city": "Dayton",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454145803",
            "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": "4160 Little York Rd Ste 20",
            "city": "Dayton",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454145803",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "MAUS",
            "middle_name": "MARIE",
            "prefix": "DR.",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.