Individual provider Active NPI

Kayla Marie Sisson

  • Student in an Organized Health Care Education/Training Program
  • Dayton, OH
National Provider Identifier
1609620004
Registry record updated Jun 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
30 E Apple St Ste 6258
Dayton, OH 45409-2939
Phone
(937) 208-8000
NPI assigned
Apr 15, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 4, 2024

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 Primary
Surgery Physician 208600000X 58.034151 OH

Addresses

Primary practice location

30 E Apple St Ste 6258
Dayton, OH 45409-2939

Mailing address

30 E Apple St Ste 6258
Dayton, OH 45409-2939
Phone (937) 208-8000

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
I20240530001821 OH Order and Referring Only - General SurgeryPractitioner - General Surgery 8022450477

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1713139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717459200000",
    "number": "1609620004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 E APPLE ST STE 6258",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454092939",
            "telephone_number": "937-208-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 E APPLE ST STE 6258",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454092939",
            "telephone_number": "937-208-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SISSON",
        "first_name": "KAYLA",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-04-15",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "58.034151",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.