Jacqueline L Roethlisberger, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

COA 03334 NP Issued in OH

Practice address

3700 Southern Blvd Ste 201
Kettering, OH 45429-1265

Phone

(855) 500-2873

Fax

(937) 281-3992

NPI assigned

Mar 28, 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

Electronic endpoints 2

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Kettering Independent Medical Group IncGroup PAC ID 3173710936, 699 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kettering Health Dayton Hospital, Dayton, OH, CCN 360133
• Kettering Health Main Campus Hospital, Kettering, OH, CCN 360079
• Kettering Health Miamisburg Hospital, Miamisburg, OH, CCN 360239
• Soin Medical Center Hospital, Beaver Creek, OH, CCN 360360
• Fort Hamilton Hughes Memorial Hospital Hospital, Hamilton, OH, CCN 360132

Merit-based Incentive Payment System (MIPS)

Final score

81.34 of 100Reported as group

Quality

63.67

Promoting interoperability

100

Improvement activities

40

Cost

74.14

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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 and National Provider Directory roles.

• Kettering Independent Medical Group Inc

  • Orthopaedic Surgery Physician
  • Miamisburg, OH
  • NPI 1629387865
  Medicare reassignment Care Compare group NPD
• University of Cincinnati Physicians Company, LLC

  • Family Medicine Physician
  • Cincinnati, OH
  • NPI 1801840434
  Medicare reassignment NPD
• Alliance Physician Inc

  • Gynecologic Oncology Physician
  • Kettering, OH
  • NPI 1710269113
  NPD (past)
• Dayton Physicians, LLC

  • Durable Medical Equipment & Medical Supplies
  • Dayton, OH
  • NPI 1811141559
  NPD (past)
• Dayton Physicians, LLC

  • Hematology & Oncology Physician
  • Dayton, OH
  • NPI 1902844947
  NPD (past)
• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

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

• Beavercreek Medical Center

  • General Acute Care Hospital
  • Beavercreek, OH
  • NPI 1760764849
  Care Compare affiliation
• Dayton Osteopathic Hospital

  • General Acute Care Hospital
  • Dayton, OH
  • NPI 1053339507
  Care Compare affiliation
• Kettering Medical Center

  • General Acute Care Hospital
  • Kettering, OH
  • NPI 1043233984
  Care Compare affiliation
• Kettering Medical Center

  • General Acute Care Hospital
  • Miamisburg, OH
  • NPI 1316966518
  Care Compare affiliation
• The Fort Hamilton Hospital

  • General Acute Care Hospital
  • Hamilton, OH
  • NPI 1104867167
  Care Compare affiliation

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649721600000",
    "number": "1366561870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PRESTIGE PL STE 550",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453426115",
            "telephone_number": "937-762-1310",
            "fax_number": "937-522-8068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 SOUTHERN BLVD STE 201",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454291265",
            "telephone_number": "855-500-2873",
            "fax_number": "937-281-3992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROETHLISBERGER",
        "first_name": "JACQUELINE",
        "middle_name": "L",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-28",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OH",
            "license": "RN 199132 COA",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OH",
            "license": "COA 03334 NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2731806",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "3700 Southern Blvd Ste 201",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454291265",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jroethlisberger199058@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "3700 Southern Blvd Ste 201",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454291265",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Patricia Ann Robinson, BS LSW
• Tara Robinson
• Tonya Robinson, R.N.
• Katlyn Robison, NP
• Jaclyn Nicole Roell, M.A.
• Bryan Rogers, ATC
• Lynn Diane Rogers, RNFA
• Katrina Lynn Rohlfs, MD
• Jason R Roller, PA-C
• Stephanie Elizabeth Roller, PA-C

• Adult Health Nurse Practitioner in Kettering, OH
• Providers in Kettering, OH by specialty
• Adult Health Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2022; 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.