Individual provider Active NPI

Kendall Erdahl, MD

  • Family Medicine Physician
  • Troy, OH
National Provider Identifier
1427263292
Registry record updated Jan 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35.090038 Issued in OH
Practice address
600 W Main St Ste 330
Troy, OH 45373-3384
Phone
(937) 980-7400
Fax
(937) 980-7409
NPI assigned
May 14, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35.090038 OH Primary

Addresses

Primary practice location

600 W Main St Ste 330
Troy, OH 45373-3384

Mailing address

600 W Main St Ste 330
Troy, OH 45373-3384
Phone (937) 980-7400

Other identifiers 1

IdentifierTypeStateIssuer
2785848MedicaidOH

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kerdahl171515@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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070716000087 OH Practitioner - Family Practice 1951401272 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wright State University Boonshoft School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alliance Physicians IncGroup PAC ID 0840104360, 314 clinicians

Practice addresses (Care Compare)

1625 S Alex Rd
West Carrollton, OH 45449-5404
Phone (937) 865-0534

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Upper Valley Family Care, Inc Family Medicine Current Accepting new patients
Alliance Physicians Inc Family Medicine CurrentSince Apr 1, 2017 Accepting new patients
Alliance Physicians Inc Family Medicine CurrentSince Apr 1, 2017 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

1 Prestige Pl
Ste 550
Miamisburg, OH 45342
Phone (937) 752-2306

200 Kienle Dr
Piqua, OH 45356
Phone (937) 339-5355

700 S Stanfield Rd
Ste 1
Troy, OH 45373

700 S Stanfield Rd
Troy, OH 45373
Phone (937) 335-7121

600 W Main St
Ste 330
Troy, OH 45373
Phone (937) 429-7350

700 S Stanfield Rd
#1
Troy, OH 45373
Phone (937) 339-5355

700 S Stanfield Rd
Ste A
Troy, OH 45373
Phone (934) 339-5355

1625 S Alex Rd
West Carrollton, OH 45449
Phone (937) 865-0534

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 6

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": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610409600000",
    "number": "1427263292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 W MAIN ST STE 330",
            "city": "TROY",
            "state": "OH",
            "postal_code": "453733384",
            "telephone_number": "937-980-7400",
            "fax_number": "937-980-7409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 W MAIN ST STE 330",
            "city": "TROY",
            "state": "OH",
            "postal_code": "453733384",
            "telephone_number": "937-980-7400",
            "fax_number": "937-980-7409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERDAHL",
        "first_name": "KENDALL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-14",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.090038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2785848",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kerdahl171515@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "600 W Main St Ste 330",
            "city": "Troy",
            "state": "OH",
            "country_code": "US",
            "postal_code": "453733384",
            "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": "600 W Main St Ste 330",
            "city": "Troy",
            "state": "OH",
            "country_code": "US",
            "postal_code": "453733384",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Troy, OH

Sources for this page

Verify at the official NPI Registry.