Individual provider Active NPI

Karl G Rose, M.D.

  • Family Medicine Physician
  • Kettering, OH
National Provider Identifier
1235136029
Registry record updated Jun 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35058825R Issued in OH
Practice address
3017 Wilmington Pike
Kettering, OH 45429-4001
Phone
(937) 294-2555
Fax
(937) 294-3211
NPI assigned
Jul 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35058825R OH Primary

Addresses

Primary practice location

3017 Wilmington Pike
Kettering, OH 45429-4001

Mailing address

3017 Wilmington Pike
Kettering, OH 45429-4001
Phone (937) 294-2555

Other identifiers 1

IdentifierTypeStateIssuer
0848855MedicaidOH

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
I20120103000482 OH Practitioner - Family Practice 8123294709 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Ohio State University College of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3017 Wilmington Pike
Dayton, OH 45429-4071
Phone (937) 294-2555

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
23.7 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
79.01

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35058825ROHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Karl G. Rose M.D., Inc. Family Medicine CurrentSince Jun 1, 2019 Accepting new patients

Locations

3017 Wilmington Pike
Kettering, OH 45429
Phone (937) 294-2555

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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560988800000",
    "number": "1235136029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3017 WILMINGTON PIKE",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454294001",
            "telephone_number": "937-294-2555",
            "fax_number": "937-294-3211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3017 WILMINGTON PIKE",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454294001",
            "telephone_number": "937-294-2555",
            "fax_number": "937-294-3211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "KARL",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2019-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35058825R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0848855",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kettering, OH

Sources for this page

Verify at the official NPI Registry.