Individual provider Active NPI

Derek Kwakye

  • Internal Medicine Physician
  • Cincinnati, OH
National Provider Identifier
1467080150
Registry record updated Apr 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35.147378 Issued in OH
Practice address
3130 Highland Ave
Cincinnati, OH 45219-2399
Phone
(513) 584-4503
Fax
(513) 584-0462
NPI assigned
Mar 30, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 35.147378 OH Primary

Addresses

Primary practice location

3130 Highland Ave
Cincinnati, OH 45219-2399

Mailing address

PO Box 636256
Cincinnati, OH 45263-6256
Phone (513) 585-6200

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
I20230804002908 OH Practitioner - Internal Medicine 7810301645 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.147378OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Cincinnati Medical Center, LLC Current Accepting new patients
University of Cincinnati Physicians Company, LLC Internal Medicine CurrentSince Jul 1, 2023 Accepting new patients
University Surgical-Dental Associates, LLC Past Accepting new patients

Locations

3199 Highland Ave
#781
Cincinnati, OH 45219
Phone (513) 585-4505

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

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

3130 Highland Ave
Cincinnati, OH 45219
Phone (513) 584-4061

3200 Burnet Ave
#2
Cincinnati, OH 45229
Phone (513) 585-5505

Interoperability endpoints

  • Direct secure messaging: dkwakye166207@direct.uchealth.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1585526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681171200000",
    "number": "1467080150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 636256",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452636256",
            "telephone_number": "513-585-6200",
            "fax_number": "513-524-5136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3130 HIGHLAND AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452192399",
            "telephone_number": "513-584-4503",
            "fax_number": "513-584-0462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWAKYE",
        "first_name": "DEREK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-30",
        "last_updated": "2023-04-11",
        "certification_date": "2023-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35.147378",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

Verify at the official NPI Registry.