Individual provider Active NPI

Karen M. Buddendeck, RN,MS,CNP,APRN

  • Adult Health Nurse Practitioner
  • Miamisburg, OH
National Provider Identifier
1407956790
Registry record updated Oct 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
COA 07257-NP Issued in OH
Practice address
4000 Miamisburg Centerville Rd Ste 410
Miamisburg, OH 45342-3758
Phone
(937) 384-4511
Fax
(937) 384-4501
NPI assigned
Sep 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 3004930 KY
Adult Health Nurse Practitioner 363LA2200X COA 07257-NP OH Primary

Addresses

Primary practice location

4000 Miamisburg Centerville Rd Ste 410
Miamisburg, OH 45342-3758

Mailing address

4000 Miamisburg Centerville Rd. Ste. 420
Miamisburg, OH 45342-7615
Phone (937) 384-4511

Other identifiers 2

IdentifierTypeStateIssuer
7100076710MedicaidKY
2367460MedicaidOH

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kbuddendeck631093@direct.ketteringhealth.org
FHIR URL https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090520000640 OH Practitioner - Nurse Practitioner 4587765698 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2001
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)

4000 Miamisburg Centerville Rd
Miamisburg, OH 45342-7615

4403 Far Hills Ave
Kettering, OH 45429-2405
Phone (937) 433-5309

4441 Far Hills Ave
Kettering, OH 45429-2405
Phone (937) 298-7751

Hospital & facility affiliations

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Master of Science, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
COA 07257-NPOHMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kettering Independent Medical Group Inc CurrentSince Dec 29, 2022 Accepting new patients
Tri-State Advanced Pain Management Past Accepting new patients
Tri-State Advanced Pain Management PLLC Past Accepting new patients
Mitchell E. Simons, M.D., PSC Past Accepting new patients

Locations

4403 Far Hills Ave
Kettering, OH 45429
Phone (937) 395-3910

4000 Miamisburg Centerville Rd
Ste 420
Miamisburg, OH 45342
Phone (937) 384-4511

4000 Miamisburg Centerville Rd
Ste 410
Miamisburg, OH 45342
Phone (937) 384-8773

Organizations & group practices 4

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": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1407956790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 MIAMISBURG CENTERVILLE RD. STE. 420",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453427615",
            "telephone_number": "937-384-4511",
            "fax_number": "937-384-4501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 MIAMISBURG CENTERVILLE RD STE 410",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453423758",
            "telephone_number": "937-384-4511",
            "fax_number": "937-384-4501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUDDENDECK",
        "first_name": "KAREN",
        "middle_name": "M.",
        "name_prefix": "Ms.",
        "credential": "RN,MS,CNP,APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-25",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "KY",
            "license": "3004930",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OH",
            "license": "COA 07257-NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100076710",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2367460",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kbuddendeck631093@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "4000 Miamisburg Centerville Rd. Ste. 420",
            "city": "Miamisburg",
            "state": "OH",
            "country_code": "US",
            "postal_code": "453427615",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "4000 Miamisburg Centerville Rd. Ste. 420",
            "city": "Miamisburg",
            "state": "OH",
            "country_code": "US",
            "postal_code": "453427615",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Miamisburg, OH

Sources for this page

Verify at the official NPI Registry.