NPIMap

Individual provider Active NPI

Amanda Gedeit, D.O

  • Family Medicine Physician
  • Kettering, OH
National Provider Identifier
1154760999
Registry record updated Apr 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
34.012303 Issued in OH
Practice address
1900 Composite Dr
Kettering, OH 45420-1475
Phone
(937) 293-8419
Fax
(937) 293-1545
NPI assigned
Jun 14, 2013
Last updated
Apr 15, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2024

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
Family Medicine Physician 207Q00000X 34.012303 OH Primary

Addresses

Primary practice location

1900 Composite Dr
Kettering, OH 45420-1475

Mailing address

1900 Composite Dr
Kettering, OH 45420-1475
Phone (937) 293-8419

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160802003290 OH Practitioner - Family Practice 1052541398 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1900 Composite Dr
Kettering, OH 45420-1475
Phone (937) 293-8419

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

State licenses

LicenseStateTypeSpecialty
34.012303OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Integrated Medical Assoc LTD Family Medicine Current Accepting new patients
Premier Integrated Medical Associates, LTD Family Medicine CurrentSince Apr 8, 2019 Accepting new patients
Premier Integrated Medical Assoc LTD Family Medicine CurrentSince Apr 8, 2019 Accepting new patients

Locations

25 Merchant St
Ste 220
Cincinnati, OH 45246

1900 Composite Dr
Kettering, OH 45420
Phone (937) 293-8419

3080 Ackerman Blvd
Ste 220
Kettering, OH 45429
Phone (937) 294-3228

243 W Central Ave
Springboro, OH 45066
Phone (513) 748-4814

235 W National Rd
Vandalia, OH 45377
Phone (937) 531-0113

Organizations & group practices 3

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 7

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": "1371168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713139200000",
    "number": "1154760999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 COMPOSITE DR",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454201475",
            "telephone_number": "937-293-8419",
            "fax_number": "937-293-1545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 COMPOSITE DR",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454201475",
            "telephone_number": "937-293-8419",
            "fax_number": "937-293-1545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GEDEIT",
        "first_name": "AMANDA",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-14",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "34.012303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kettering, OH

Sources for this page

Verify at the official NPI Registry.