Individual provider Active NPI

Raeanne Hunter Fondriest, AG-ACNP

  • Acute Care Nurse Practitioner
  • Beavercreek, OH
National Provider Identifier
1194105692
Registry record updated Jan 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
COA.17372-NP Issued in OH
Practice address
3535 Pentagon Blvd
Beavercreek, OH 45431-1705
Phone
(937) 702-4024
Fax
(937) 702-4035
NPI assigned
Jun 1, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 14, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X COA.17372-NP OH Primary

Addresses

Primary practice location

3535 Pentagon Blvd
Beavercreek, OH 45431-1705

Mailing address

3535 Pentagon Blvd
Beavercreek, OH 45431-1705
Phone (937) 702-4024

Other practice location 1

2222 Philadelphia Dr
Dayton, OH 45406-1813
Phone (937) 734-3516

Other practice location 2

2400 Miami Valley Dr
Centerville, OH 45459-4774
Phone (937) 208-8394

Other names 1

  • Miss Raeanne Hunter Schafer Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address rfondriest667017@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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170809001192 OH Practitioner - Nurse Practitioner 6800167842 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Wright State University Boonshoft School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Premier Health Specialists IncGroup PAC ID 5597708594, 576 clinicians

Practice addresses (Care Compare)

1 Medical Ctr Dr
FL 3
Middletown, OH 45005-2584
Phone (513) 974-5197

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.38 of 100Reported as group
Quality
66.25
Promoting interoperability
100
Improvement activities
40
Cost
71.69

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
COA.17372-NPOHMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kettering Independent Medical Group Inc CurrentSince Dec 29, 2022 Accepting new patients
Premier Health Specialists Inc CurrentSince Jul 3, 2017 Accepting new patients
Rajesh C Patel MD Inc CurrentSince Jul 1, 2022 Accepting new patients
Rajesh C. Patel, M.D., Inc. CurrentSince Jul 1, 2022 Accepting new patients
Premier Health Specialists Inc CurrentSince Jul 3, 2017 Accepting new patients
Premier Heart Associates, Inc Past Accepting new patients

Locations

3535 Pentagon Blvd
Beavercreek, OH 45431
Phone (937) 702-4000

9001 N Main St
Ste A
Dayton, OH 45415
Phone (937) 832-0990

30 E Apple St
#6258
Dayton, OH 45409
Phone (937) 208-5300

2400 Miami Valley Dr
Dayton, OH 45459
Phone (937) 208-8394

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

1 Medical Center Dr
#3
Middletown, OH 45005

1 Medical Center Dr
Fl 3
Middletown, OH 45005
Phone (513) 974-5197

3170 Kettering Blvd
Bldg B
Moraine, OH 45439
Phone (937) 991-3187

450 N Hyatt St
Ste 304
Tipp City, OH 45371
Phone (937) 832-4773

1141 N Monroe Dr
Xenia, OH 45385
Phone (937) 352-2000

Organizations & group practices 6

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 1

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": "1433116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610582400000",
    "number": "1194105692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 PENTAGON BLVD",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454311705",
            "telephone_number": "937-702-4024",
            "fax_number": "937-702-4035"
        },
        {
            "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": "937-702-4024",
            "fax_number": "937-702-4035"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2222 Philadelphia Dr",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454061813",
            "country_code": "US",
            "telephone_number": "937-734-3516",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2400 Miami Valley Dr",
            "address_purpose": "LOCATION",
            "city": "Centerville",
            "state": "OH",
            "postal_code": "454594774",
            "country_code": "US",
            "telephone_number": "937-208-8394",
            "fax_number": "937-208-8388",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FONDRIEST",
        "first_name": "RAEANNE",
        "middle_name": "HUNTER",
        "name_prefix": "Mrs.",
        "credential": "AG-ACNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-01",
        "last_updated": "2021-01-14",
        "certification_date": "2021-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "OH",
            "license": "COA.17372-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rfondriest667017@direct.ketteringhealth.org",
            "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": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "3535 Pentagon Blvd",
            "city": "Beavercreek",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454311705",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "RAEANNE",
            "last_name": "SCHAFER",
            "middle_name": "HUNTER",
            "prefix": "MISS",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Beavercreek, OH

Sources for this page

Verify at the official NPI Registry.