Individual provider Active NPI

Richard Kallenberg, MD

  • Internal Medicine Physician
  • West Chester, OH
National Provider Identifier
1336189349
Registry record updated Dec 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35051241 Issued in OH
Practice address
8040 Princeton Glendale Rd
West Chester, OH 45069-5802
Phone
(513) 246-7000
Fax
(513) 246-5479
NPI assigned
Jun 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35051241 OH Primary

Addresses

Primary practice location

8040 Princeton Glendale Rd
West Chester, OH 45069-5802

Mailing address

4685 Forest Ave Ste C
Cincinnati, OH 45212-3359
Phone (513) 246-7800

Other identifiers 1

IdentifierTypeStateIssuer
2043863MedicaidOH

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
I20050609000346 OH Practitioner - Internal Medicine 0143263210 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35051241OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Trihealth G, LLC CurrentSince Jul 1, 2005 Accepting new patients
Trihealth G LLC Internal Medicine CurrentSince Jul 1, 2005 Accepting new patients

Locations

2001 Anderson Ferry Rd
Cincinnati, OH 45238
Phone (513) 922-1200

9070 Winton Rd
Cincinnati, OH 45231
Phone (513) 246-2750

2915 Clifton Ave
Cincinnati, OH 45220
Phone (513) 872-2000

4685 Forest Ave
Cincinnati, OH 45212
Phone (513) 853-4721

4685 Forest Ave
Ste C
Norwood, OH 45212
Phone (513) 246-7796

8040 Princeton Glendale Rd
West Chester, OH 45069
Phone (513) 346-5065

Interoperability endpoints

  • Direct secure messaging: rkallenberg29@direct.trihealth.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1419811200000",
    "number": "1336189349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4685 FOREST AVE STE C",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452123359",
            "telephone_number": "513-246-7800",
            "fax_number": "513-246-7852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8040 PRINCETON GLENDALE RD",
            "city": "WEST CHESTER",
            "state": "OH",
            "postal_code": "450695802",
            "telephone_number": "513-246-7000",
            "fax_number": "513-246-5479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALLENBERG",
        "first_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2014-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35051241",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2043863",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Chester, OH

Sources for this page

Verify at the official NPI Registry.