Individual provider Active NPI

Jonathan Woody

  • Physician Assistant
  • Kettering, OH
National Provider Identifier
1629600028
Registry record updated Apr 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
3700 Southern Blvd Ste 300
Kettering, OH 45429-1265
Phone
(937) 643-9299
NPI assigned
Feb 4, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 50.006352RX OH
Physician Assistant 363A00000X 50.006352RX OH
Physician Assistant 363A00000X OH Primary

Addresses

Primary practice location

3700 Southern Blvd Ste 300
Kettering, OH 45429-1265

Mailing address

1 Prestige PL
Ste 550
Miamisburg, OH 45342-6115
Phone (937) 762-1310

Other practice location 1

10500 Montgomery Rd
Cincinnati, OH 45242-4402
Phone (513) 865-1111

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jwoody756587@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
I20200319000987 OH Practitioner - Physician Assistant 9537597877 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Physicians, Inc. CurrentSince Mar 19, 2021 Accepting new patients
Alliance Physicians Inc CurrentSince Mar 19, 2021 Accepting new patients

Locations

3535 Pentagon Blvd
Ste 230
Beavercreek, OH 45431
Phone (855) 500-2873

3700 Southern Blvd
Ste 300
Kettering, OH 45429
Phone (937) 395-8002

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

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

Interoperability endpoints

  • Direct secure messaging: jwoody307933@direct.trihealth.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": "1580774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617580800000",
    "number": "1629600028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PRESTIGE PL",
            "address_2": "STE 550",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453426115",
            "telephone_number": "937-762-1310",
            "fax_number": "937-522-8068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 SOUTHERN BLVD STE 300",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454291265",
            "telephone_number": "937-643-9299"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10500 Montgomery Rd",
            "address_purpose": "LOCATION",
            "city": "Cincinnati",
            "state": "OH",
            "postal_code": "452424402",
            "country_code": "US",
            "telephone_number": "513-865-1111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOODY",
        "first_name": "JONATHAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-04",
        "last_updated": "2021-04-05",
        "certification_date": "2021-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "50.006352RX",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.006352RX",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jwoody756587@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "3700 Southern Blvd Ste 300",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454291265",
            "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": "3700 Southern Blvd Ste 300",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454291265",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kettering, OH

Sources for this page

Verify at the official NPI Registry.