NPIMap

Individual provider Active NPI

Samuel Jacob Dedden

  • Physician Assistant
  • Edgewood, KY
National Provider Identifier
1700422995
Registry record updated Nov 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
560 S Loop Rd
Edgewood, KY 41017-3405
Phone
(859) 301-2663
NPI assigned
Nov 21, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

560 S Loop Rd
Edgewood, KY 41017-3405

Mailing address

4842 Dartmouth Dr
Burlington, KY 41005-9132
Phone (859) 803-7696

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, OH2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200123001129 KY Practitioner - Physician Assistant 2062847957 Reassigns benefits to 1 organization
I20200603001142 OH Practitioner - Physician Assistant 2062847957 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Kentucky College of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthocincy Orthopaedics and Sports Medicine PSC 163 clinicians

Practice addresses (Care Compare)

2123 Auburn Ave
Suite 630
Cincinnati, OH 45219-2906
Phone (859) 301-2663

2626 Alexandria Pike
Suite 100
Highland Heights, KY 41076-1530
Phone (859) 301-2663

2845 Chancellor Dr
Crestview Hills, KY 41017-3418
Phone (859) 301-2663

560 S Loop Rd
Edgewood, KY 41017-3405

7910 Beechmont Ave
Cincinnati, OH 45255-4210
Phone (513) 232-2663

Hospital & facility affiliations

  • St Elizabeth Edgewood Hospital, Edgewood, KY, CCN 180035
  • St Elizabeth Ft Thomas Hospital, Fort Thomas, KY, CCN 180001
  • St Elizabeth Florence Hospital, Florence, KY, CCN 180045
  • St Elizabeth Grant Hospital, Williamstown, KY, CCN 181311
  • Christ Hospital Hospital, Cincinnati, OH, CCN 360163

Merit-based Incentive Payment System (MIPS)

Final score
93.01 of 100Reported as apm
Quality
86.02
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Orthocincy Orthopaedics & Sports Medicine PSC CurrentSince Dec 19, 2019 Accepting new patients
Orthocincy Orthopaedics & Sports Medicine PSC Physician Assistant CurrentSince Dec 19, 2019 Accepting new patients

Locations

2845 Chancellor Dr
Crestview Hills, KY 41017
Phone (859) 341-3412

560 S Loop Rd
Edgewood, KY 41017
Phone (859) 817-3599

2626 Alexandria Pike
Ste 100
Highland Heights, KY 41076
Phone (859) 817-3599

2123 Auburn Ave
Ste 630
Cincinnati, OH 45219
Phone (513) 585-1970

Interoperability endpoints

  • Direct secure messaging: sdedden300400@direct-prd.stelizabeth.com

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 5

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": "1574294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574294400000",
    "number": "1700422995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4842 DARTMOUTH DR",
            "city": "BURLINGTON",
            "state": "KY",
            "postal_code": "410059132",
            "telephone_number": "859-803-7696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 S LOOP RD",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410173405",
            "telephone_number": "859-301-2663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEDDEN",
        "first_name": "SAMUEL",
        "middle_name": "JACOB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-21",
        "last_updated": "2019-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgewood, KY

Sources for this page

Verify at the official NPI Registry.