Active NPI
Carol A Amfahr, C.N.P.
- Adult Health Nurse Practitioner
- Kettering, OH
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- APRN.CNP.08082
- Practice address
- 3700 Southern Blvd Ste 401
Kettering, OH 45429-1226 - Phone
- (855) 500-2873
- Fax
- (937) 281-3913
- NPI assigned
- Nov 21, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | COA 08082 NP | OH | |
| Adult Health Nurse Practitioner | 363LA2200X | APRN.CNP.08082 | OH | Primary |
Addresses
Primary practice location
3700 Southern Blvd Ste 401
Kettering, OH 45429-1226
Mailing address
3700 Southern Blvd Ste 401
Kettering, OH 45429-1226
Phone (855) 500-2873
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000000363681 | Other | OH | ANTHEM |
| 2543493 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201113000453 | IL | Practitioner - Nurse Practitioner | 6406805027 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Osf Multi-Specialty Group
Practice addresses (Care Compare)
1400 W Park St
Urbana, IL 61801-2334
Phone (217) 337-2000
812 N Logan Ave
Danville, IL 61832-3752
Phone (217) 443-5000
8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| COA 08082 NP | OH | MD | Adult Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central PA Pharmacy LLC. | Current | Accepting new patients | |
| Osf Multi-Specialty Group | Current | Accepting new patients |
Locations
8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050
1400 W Park St
Urbana, IL 61801
Phone (217) 337-2000
Organizations & group practices 2
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.
-
- Community/Retail Pharmacy
- Patton, PA
- NPI 1578541413
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1538438400000",
"number": "1245305051",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3700 SOUTHERN BLVD STE 401",
"city": "KETTERING",
"state": "OH",
"postal_code": "454291226",
"telephone_number": "855-500-2873",
"fax_number": "937-281-3913"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3700 SOUTHERN BLVD STE 401",
"city": "KETTERING",
"state": "OH",
"postal_code": "454291226",
"telephone_number": "855-500-2873",
"fax_number": "937-281-3913"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AMFAHR",
"first_name": "CAROL",
"middle_name": "A",
"credential": "C.N.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-21",
"last_updated": "2018-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "OH",
"license": "COA 08082 NP",
"primary": false
},
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "OH",
"license": "APRN.CNP.08082",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "0000000363681",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2543493",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Kettering, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2018; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.