Gregory James Staten, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

50.001631RX Issued in OH

Practice address

4421 Roosevelt Blvd
Middletown, OH 45044-9023

Phone

(833) 510-4357

NPI assigned

Jan 5, 2006

Last updated

Nov 28, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts, Physician Assistant

State licenses

Practice roles

Locations

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.

• Alliance Physicians Inc

  dba Kettering Health Medical Group

  • Family Medicine Physician
  • Kettering, OH
  • NPI 1437125572
  Medicare reassignment NPD
• Brightview, LLC

  • Addiction Medicine (Internal Medicine) Physician
  • Cincinnati, OH
  • NPI 1659769446
  Medicare reassignment NPD
• Kettering Independent Medical Group Inc

  • Orthopaedic Surgery Physician
  • Miamisburg, OH
  • NPI 1629387865
  Medicare reassignment
• Alliance Physician Inc

  dba Kettering Sports Medicine

  • Sports Medicine (Family Medicine) Physician
  • Kettering, OH
  • NPI 1821160243
  NPD
• Brightview LLC

  • Addiction Medicine (Internal Medicine) Physician
  • Asheboro, NC
  • NPI 1962163782
  NPD
• Samaritan Emergency Corp

  • Emergency Medicine Physician
  • Dayton, OH
  • NPI 1922084136
  NPD (past)
• Radadvantage a Professional Corporation

  • Diagnostic Radiology Physician
  • Phoenix, AZ
  • NPI 1376719666
  NPD (past)
• Virtual Radiologic Professionals, LLC

  • Diagnostic Radiology Physician
  • Edina, MN
  • NPI 1932342029
  NPD (past)

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

{
    "created_epoch": "1136419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701129600000",
    "number": "1194703660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 MONTGOMERY RD STE 400",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452122600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4421 ROOSEVELT BLVD",
            "city": "MIDDLETOWN",
            "state": "OH",
            "postal_code": "450449023",
            "telephone_number": "833-510-4357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STATEN",
        "first_name": "GREGORY",
        "middle_name": "JAMES",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-05",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.001631RX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0085239",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gstaten471285@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "3533 Southern Blvd Ste 2100",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454291267",
            "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": "3533 Southern Blvd Ste 2100",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454291267",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Matthew Warden Sprowls, D.D.S. M.S.D.
• Taylor Squires
• Paige Stafford
• Melissa K Stamper, LPCC, LICDC
• Alyrah Stanford
• Barbara Lee Steel, MD
• Earlene Claire Steele-Pridemore, CNP
• Lauren Nicole Steele, PHARMD
• Malcolm Lori Steiner, MD
• Ryan D. Steinmetz, MD

• Physician Assistant in Middletown, OH
• Providers in Middletown, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.