Anna Ketcham

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

COA.17080-NP Issued in OH

Practice address

3572 Dayton Xenia Rd
Suite 105
Beavercreek, OH 45432-2886

Phone

(937) 427-4600

NPI assigned

May 4, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dermatologists of Southwestern Ohio, LLCGroup PAC ID 7113973041, 116 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

99.15 of 100Reported as group

Promoting interoperability

99

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amk@dermswohio.emadirect.md

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.

• Dermatologists of Southwestern Ohio, LLC.

  • Dermatology Physician
  • Dayton, OH
  • NPI 1801819883
  Medicare reassignment Care Compare group NPD
• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

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

{
    "created_epoch": "1430697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496880000000",
    "number": "1669859229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3572 DAYTON-XENIA RD.",
            "address_2": "STE. 105",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454322838",
            "telephone_number": "937-427-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3572 DAYTON XENIA RD",
            "address_2": "SUITE 105",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454322886",
            "telephone_number": "937-427-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETCHAM",
        "first_name": "ANNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-04",
        "last_updated": "2017-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "COA.17080-NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS",
            "identifier": "000000966352",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Delaine Lynn Kendo, PA-C
• Erin Kennedy, CNP
• Katelyn Rene Kerns, RN
• Heather Kerubo, NP
• Todd Kessler
• Kettering Independent Medical Group Inc
• Kevin R. Schroeder, DPM
• Khalid Transportation Company (Atc)
• Mukarram Ali Khan, D.O.
• Scott Robert Kidd, PHARMD

• Family Nurse Practitioner in Beavercreek, OH
• Providers in Beavercreek, OH by specialty
• Family Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2017; 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.