NPIMap

Individual provider Active NPI

Kurt Andrew Fleagle, M.D.

  • Internal Medicine Physician
  • Kettering, OH
National Provider Identifier
1750382602
Registry record updated May 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35067242 Issued in OH
Practice address
5250 Far Hills Ave Ste 210
Kettering, OH 45429-2353
Phone
(937) 434-4775
Fax
(833) 450-5129
NPI assigned
Aug 2, 2005
Last updated
May 5, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35067242 OH Primary

Addresses

Primary practice location

5250 Far Hills Ave Ste 210
Kettering, OH 45429-2353

Mailing address

5250 Far Hills Ave Ste 210
Kettering, OH 45429-2353
Phone (937) 434-4775

Other identifiers 3

IdentifierTypeStateIssuer
000000348732OtherOHANTHEM
352238745001OtherOHMEDICAL MUTUAL
0264904MedicaidOH

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
I20041220000797 OH Practitioner - Internal Medicine 1951369149 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Wright State University Boonshoft School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5250 Far Hills Ave
Suite 210
Dayton, OH 45429-2353
Phone (937) 434-4775

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35067242OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fleagle Internal Medicine LLC Internal Medicine CurrentSince Jan 1, 2005 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Alliance Physicians Inc Internal Medicine Past Accepting new patients

Locations

5250 Far Hills Ave
Ste 210
Kettering, OH 45429
Phone (937) 434-4775

5678 Far Hills Ave
Kettering, OH 45429
Phone (937) 279-8630

Interoperability endpoints

  • Direct secure messaging: kurt.fleagle.1@30706.direct.athenahealth.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714867200000",
    "number": "1750382602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5250 FAR HILLS AVE STE 210",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454292353",
            "telephone_number": "937-434-4775",
            "fax_number": "937-434-4779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5250 FAR HILLS AVE STE 210",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454292353",
            "telephone_number": "937-434-4775",
            "fax_number": "833-450-5129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLEAGLE",
        "first_name": "KURT",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-02",
        "last_updated": "2024-05-05",
        "certification_date": "2024-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35067242",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000348732",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL MUTUAL",
            "identifier": "352238745001",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0264904",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kettering, OH

Sources for this page

Verify at the official NPI Registry.