NPIMap

Individual provider Active NPI

John Paul Detherage III, MD

  • Emergency Medicine Physician
  • Montgomery, OH
National Provider Identifier
1447833504
Registry record updated Nov 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
35150486 Issued in OH
Practice address
10506 Montgomery Rd Ste 209
Montgomery, OH 45242-4400
Phone
(513) 865-9040
NPI assigned
May 5, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 3, 2025

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 59124 KY
Sports Medicine (Emergency Medicine) Physician 207PS0010X 01098271A IN
Sports Medicine (Emergency Medicine) Physician 207PS0010X 35150486 OH
Emergency Medicine Physician 207P00000X 01098271A IN
Emergency Medicine Physician 207P00000X 35150486 OH Primary
Sports Medicine (Emergency Medicine) Physician 207PS0010X 59124 KY

Addresses

Primary practice location

10506 Montgomery Rd Ste 209
Montgomery, OH 45242-4400

Mailing address

10506 Montgomery Rd Ste 209
Montgomery, OH 45242-4400

Other practice location 1

7910 Beechmont Ave
Cincinnati, OH 45255-4210
Phone (513) 232-2663

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, KY, IN3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20240828003117 OH Practitioner - Emergency MedicinePractitioner - Sports Medicine 1355792763 Reassigns benefits to 3 organizations
I20251113002322 KY Practitioner - Emergency MedicinePractitioner - Sports Medicine 1355792763 Reassigns benefits to 1 organization
I20260107002994 IN Practitioner - Emergency MedicinePractitioner - Sports Medicine 1355792763 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Sports Medicine
Education
Wright State University Boonshoft School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthocincy Orthopaedics and Sports Medicine PSC 163 clinicians

Practice addresses (Care Compare)

1600 Flossie Dr
Greendale, IN 47025-8424
Phone (859) 301-2663

560 S Loop Rd
Edgewood, KY 41017-3405
Phone (859) 301-2663

7910 Beechmont Ave
Cincinnati, OH 45255-4210
Phone (513) 232-2663

Hospital & facility affiliations

  • Bethesda North Hospital, Cincinnati, OH, CCN 360179
  • Good Samaritan Hospital Hospital, Cincinnati, OH, CCN 360134
  • McCullough-Hyde Memorial Hospital Hospital, Oxford, OH, CCN 360046

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35150486OHMDEmergency Medicine Physician
01098271AINMDSports Medicine (Emergency Medicine) Physician
59124KYMDSports Medicine (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orthocincy Orthopaedics & Sports Medicine PSC CurrentSince Jan 1, 2026 Accepting new patients
Qualified Emergency Specialists Inc Emergency Medicine CurrentSince Aug 1, 2025 Accepting new patients
Orthocincy Orthopaedics & Sports Medicine PSC CurrentSince Jan 1, 2026 Accepting new patients
University of Cincinnati Physicians Company, LLC CurrentSince Jul 1, 2024 Accepting new patients

Locations

605 Wilson Creek Rd
Lawrenceburg, IN 47025
Phone (812) 496-8779

1600 Flossie Dr
Lawrenceburg, IN 47025
Phone (812) 539-2313

560 S Loop Rd
Edgewood, KY 41017
Phone (859) 817-3599

2626 Alexandria Pike
Ste 100
Highland Heights, KY 41076
Phone (859) 817-3599

3188 Bellevue Ave
Cincinnati, OH 45219
Phone (513) 558-5281

4777 E Galbraith Rd
Cincinnati, OH 45236
Phone (513) 686-3000

8251 Pine Rd
Ste 212
Cincinnati, OH 45236
Phone 5138410222120

3200 Burnet Ave
Cincinnati, OH 45229
Phone (513) 558-7700

7910 Beechmont Ave
Cincinnati, OH 45255
Phone (513) 474-8600

2123 Auburn Ave
#A28
Cincinnati, OH 45219
Phone (513) 585-0523

4355 Ferguson Dr
Cincinnati, OH 45245
Phone (513) 221-2663

2139 Auburn Ave
Cincinnati, OH 45219
Phone (513) 585-0406

2123 Auburn Ave
Ste 630
Cincinnati, OH 45219
Phone (513) 585-1970

10500 Montgomery Rd
Montgomery, OH 45242
Phone (513) 557-3206

10506 Montgomery Rd
Ste 209
Montgomery, OH 45242
Phone (513) 794-1601

8734 Union Centre Blvd
West Chester, OH 45069

Organizations & group practices 17

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.

View all 17

Hospital & facility affiliations 7

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": "1620172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762128000000",
    "number": "1447833504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10506 MONTGOMERY RD STE 209",
            "city": "MONTGOMERY",
            "state": "OH",
            "postal_code": "452424400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10506 MONTGOMERY RD STE 209",
            "city": "MONTGOMERY",
            "state": "OH",
            "postal_code": "452424400",
            "telephone_number": "513-865-9040"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7910 Beechmont Ave",
            "address_purpose": "LOCATION",
            "city": "Cincinnati",
            "state": "OH",
            "postal_code": "452554210",
            "country_code": "US",
            "telephone_number": "513-232-2663",
            "fax_number": "859-817-7848",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DETHERAGE",
        "first_name": "JOHN",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-05-05",
        "last_updated": "2025-11-03",
        "certification_date": "2025-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "KY",
            "license": "59124",
            "primary": false
        },
        {
            "code": "207PS0010X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Sports Medicine",
            "state": "IN",
            "license": "01098271A",
            "primary": false
        },
        {
            "code": "207PS0010X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Sports Medicine",
            "state": "OH",
            "license": "35150486",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "01098271A",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "35150486",
            "primary": true
        },
        {
            "code": "207PS0010X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Sports Medicine",
            "state": "KY",
            "license": "59124",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery, OH

Sources for this page

Verify at the official NPI Registry.