Mariah Nicole Lopez, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

50.005750RX Issued in OH

Practice address

4000 Miamisburg Centerville Rd Ste 230
Miamisburg, OH 45342-7615

Phone

(937) 433-5309

NPI assigned

Nov 26, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Mariah Nicole Isaacs Former name

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in IN, OH2 enrollments

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 2

Specialty

Physician Assistant

Education

Nova Southeastern College of Osteo Medicine, 2018

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)

Hospital & facility affiliations

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Kettering Independent Medical Group Inc

  • Orthopaedic Surgery Physician
  • Miamisburg, OH
  • NPI 1629387865
  Medicare reassignment Care Compare group
• Alliance Physicians Inc

  • Family Medicine Physician
  • Kettering, OH
  • NPI 1437125572
  Medicare reassignment NPD
• Great Lakes Orthopedics & Sports Medicine, PC

  • Orthopaedic Surgery Physician
  • Saint John, IN
  • NPI 1669472270
  Medicare reassignment
• Alliance Physicians Inc

  • Infectious Disease Physician
  • Hamilton, OH
  • NPI 1851728810
  NPD
• Great Lakes Orthopedics and Sports Medicine, P.C.

  • Physical Therapist
  • Crown Point, IN
  • NPI 1336363266
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Dayton Osteopathic Hospital

  • General Acute Care Hospital
  • Dayton, OH
  • NPI 1053339507
  Care Compare affiliation
• Kettering Medical Center

  • General Acute Care Hospital
  • Kettering, OH
  • NPI 1043233984
  Care Compare affiliation
• Kettering Medical Center

  • General Acute Care Hospital
  • Miamisburg, OH
  • NPI 1316966518
  Care Compare affiliation

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

{
    "created_epoch": "1543190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660608000000",
    "number": "1639648322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2939 SUNNY DR",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454346333",
            "telephone_number": "937-321-4494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 MIAMISBURG CENTERVILLE RD STE 230",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453427615",
            "telephone_number": "937-433-5309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "MARIAH",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-11-26",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.005750RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "4000 Miamisburg Centerville Rd Ste 230",
            "city": "Miamisburg",
            "state": "OH",
            "country_code": "US",
            "postal_code": "453427615",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mlopez796029@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "4000 Miamisburg Centerville Rd Ste 230",
            "city": "Miamisburg",
            "state": "OH",
            "country_code": "US",
            "postal_code": "453427615",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARIAH",
            "last_name": "ISAACS",
            "middle_name": "NICOLE",
            "prefix": "MISS",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jaclyn Mackenzie Little, FNP
• Zi Yu Liu, MD
• Priscilla Z. Loba, L.P.C.C.
• Kimberly Lockwood
• Trystin Dominique Looker
• Marissa Christine Lord, RBT
• Nicole Loring, RBT
• Love&Carellc
• Adaiah Marie Lowery
• Marc G Lubitz, MD

• Physician Assistant in Miamisburg, OH
• Providers in Miamisburg, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.