Individual provider Active NPI

Jennifer Roberts, PA-C

  • Surgical Physician Assistant
  • Kettering, OH
National Provider Identifier
1497902944
Registry record updated Dec 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
50.002811 Issued in OH
Practice address
3533 Southern Blvd Ste 5650
Kettering, OH 45429-1263
Phone
(937) 294-3611
Fax
(937) 294-9010
NPI assigned
Aug 26, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 50.002811 OH Primary

Addresses

Primary practice location

3533 Southern Blvd Ste 5650
Kettering, OH 45429-1263

Mailing address

3533 Southern Blvd
Suite 5650
Kettering, OH 45429-1264
Phone (937) 294-3611

Other identifiers 1

IdentifierTypeStateIssuer
0743039MedicaidOH

Other names 1

  • Jennifer Schafer Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jroberts191745@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
I20081121000000 OH Practitioner - Physician Assistant 0648330670 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kettering Independent Medical Group IncGroup PAC ID 3173710936, 699 clinicians

Practice addresses (Care Compare)

2510 Commons Blvd
Suite 125
Beavercreek, OH 45431-3835
Phone (937) 454-9527

3535 Southern Blvd
Kettering, OH 45429-1221
Phone (937) 395-8646

3737 Southern Blvd
Kettering, OH 45429-1285

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

  • Kettering Health Main Campus Hospital, Kettering, OH, CCN 360079
  • Kettering Health Dayton Hospital, Dayton, OH, CCN 360133
  • Kettering Health Miamisburg Hospital, Miamisburg, OH, CCN 360239

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
Doctor of Osteopathy, Physician Assistant

State licenses

LicenseStateTypeSpecialty
50.002811OHMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Physicians Inc CurrentSince Jun 5, 2017 Accepting new patients
Alliance Physicians Inc CurrentSince Jun 5, 2017 Accepting new patients

Locations

7740 Washington Village Dr
Ste 130
Dayton, OH 45459
Phone (513) 932-4891

3737 Southern Blvd
Ste 2000
Kettering, OH 45429
Phone (937) 228-4126

3533 Southern Blvd
Ste 5650
Kettering, OH 45429
Phone (937) 294-3611

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

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

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

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.

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": "1219708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608163200000",
    "number": "1497902944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3533 SOUTHERN BLVD",
            "address_2": "SUITE 5650",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454291264",
            "telephone_number": "937-294-3611",
            "fax_number": "937-294-9010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3533 SOUTHERN BLVD STE 5650",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454291263",
            "telephone_number": "937-294-3611",
            "fax_number": "937-294-9010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JENNIFER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-26",
        "last_updated": "2020-12-17",
        "certification_date": "2020-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OH",
            "license": "50.002811",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0743039",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jroberts191745@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "3533 Southern Blvd Ste 5650",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454291263",
            "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": "3533 Southern Blvd Ste 5650",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454291263",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "SCHAFER",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Kettering, OH

Sources for this page

Verify at the official NPI Registry.