Lia R Kettenis, M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

01063824A Issued in IN

Practice address

645 S Rogers St
Bloomington, IN 47403-2353

Phone

(812) 269-5092

NPI assigned

May 21, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Specialty

Psychiatry

Education

Washington University School of Medicine, 2002

Medicare assignment

May accept Medicare assignment

Group practices

Centerstone of Indiana IncGroup PAC ID 9436138427, 114 clinicians

Centerstone Health Services IncGroup PAC ID 1850497173, 25 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Indiana University Health Bloomington Hospital Hospital, Bloomington, IN, CCN 150051

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lia.kettenis.1@24341.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/24341/brand/1/csg/1/fhir/r4

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.

• Centerstone Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Connersville, IN
  • NPI 1518528579
  Medicare reassignment Care Compare group NPD
• Centerstone of Indiana, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bloomington, IN
  • NPI 1992781470
  Medicare reassignment Care Compare group NPD
• Centerstone Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Bloomington, IN
  • NPI 1497305791
  NPD
• Centerstone Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Connersville, IN
  • NPI 1811766504
  NPD
• Centerstone of Indiana, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bloomington, IN
  • NPI 1972320224
  NPD
• Centerstone Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Columbus, IN
  • NPI 1114553948
  NPD (past)
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Indiana University Health Bloomington Inc

  • General Acute Care Hospital
  • Bloomington, IN
  • NPI 1205860335
  Care Compare affiliation

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709596800000",
    "number": "1346459146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 S ROGERS ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474032353",
            "telephone_number": "812-269-5092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 S ROGERS ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474032353",
            "telephone_number": "812-269-5092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETTENIS",
        "first_name": "LIA",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-21",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "IN",
            "license": "01063824A",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "01063824A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200871370A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Kerns
• Grace Kerulis
• Kyle J Kessens, PHARMD
• Kevin Allen Kessler, MD
• Cassidy Kestle
• Kevin J Powers
• Kevin Powers DPM
• KGC Operator, Inc.
• Rohma Khan
• Reeya Khanal, DO

• Child & Adolescent Psychiatry Physician in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Child & Adolescent Psychiatry Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2024; 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.

Verify at the official NPI Registry.