NPIMap

Individual provider Active NPI

Kent Brandeberry, D.O.

  • Family Medicine Physician
  • Lima, OH
National Provider Identifier
1629164728
Registry record updated Oct 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
34.011107 Issued in OH
Practice address
3224 Jarvis Dr
Lima, OH 45807
Phone
(419) 996-5757
Fax
(419) 996-5913
NPI assigned
Oct 5, 2006
Last updated
Oct 15, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 02003466A IN
Family Medicine Physician 207Q00000X 34.011107 OH Primary

Addresses

Primary practice location

3224 Jarvis Dr
Lima, OH 45807

Mailing address

PO Box 636930
Cincinnati, OH 45263-6930
Phone (513) 981-5123

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131108000748 OH Practitioner - Family Practice 9234364761 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Ohio University, College of Osteopathic Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Health Physicians Lima, LLCGroup PAC ID 3375607351, 54 clinicians
Mercy Health Physicians Lima Specialty Care LLCGroup PAC ID 7012332364, 254 clinicians

Practice addresses (Care Compare)

3224 Jarvis Rd
Lima, OH 45807-2213
Phone (419) 996-5757

967 Bellefontaine Ave
Lima, OH 45804-2888
Phone (419) 996-5895

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
02003466AINMDFamily Medicine Physician
34.011107OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Physicians Lima, LLC Family Medicine CurrentSince Oct 28, 2013 Accepting new patients
Mercy Health Physicians Lima Specialty Care LLC CurrentSince May 5, 2021 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
HCF of Shawnee, Inc. Past Accepting new patients
Mercy Health-St Ritas Medical Center LLC Past Accepting new patients

Locations

3224 Jarvis Rd
Lima, OH 45807
Phone (419) 996-5757

770 W High St
Ste 450
Lima, OH 45801
Phone (419) 996-5069

830 W High St
Ste 390
Lima, OH 45801
Phone (419) 995-4960

967 Bellefontaine Ave
Lima, OH 45804
Phone (419) 224-1330

Interoperability endpoints

  • Direct secure messaging: kbrandeberry87050@direct.bsmhealth.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Shawnee ManorLima, OH, CCN 365361 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 1, 2022
Jun 1, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

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": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381795200000",
    "number": "1629164728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 636930",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452636930",
            "telephone_number": "513-981-5123",
            "fax_number": "513-981-5015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3224 JARVIS DR",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "45807",
            "telephone_number": "419-996-5757",
            "fax_number": "419-996-5913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANDEBERRY",
        "first_name": "KENT",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2013-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02003466A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "34.011107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lima, OH

Sources for this page

Verify at the official NPI Registry.