Individual provider Active NPI

Olivia C Roberts, PA-C

  • Physician Assistant
  • Kettering, OH
National Provider Identifier
1750782496
Registry record updated Apr 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.004119RX Issued in OH
Practice address
3535 Southern Blvd
Kettering, OH 45429-1221
Phone
(937) 395-6665
Fax
(937) 395-6668
NPI assigned
Sep 12, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2022

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 50.004119RX OH Primary

Addresses

Primary practice location

3535 Southern Blvd
Kettering, OH 45429-1221

Mailing address

3533 Southern Blvd.
Ste. 2100
Kettering, OH 45429-1267
Phone (937) 395-8556

Other identifiers 1

IdentifierTypeStateIssuer
0110469MedicaidOH

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address oroberts603845@direct.ketteringhealth.org
FHIR URL https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/

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
I20141009001466 OH Practitioner - Physician Assistant 6901026111 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Radiology Physicians IncGroup PAC ID 9537060470, 62 clinicians
Premier Health Specialists IncGroup PAC ID 5597708594, 576 clinicians

Practice addresses (Care Compare)

1 Medical Ctr Dr
Middletown, OH 45005-2584
Phone (513) 974-2111

1 Wyoming St
Dayton, OH 45409-2722
Phone (937) 208-8000

2300 Miami Valley Dr
Centerville, OH 45459-1294

360 W Central Ave
Springboro, OH 45066-1106
Phone (937) 208-7117

450 N Hyatt St
Suite 304
Tipp City, OH 45371-1433
Phone (937) 832-4773

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.38 of 100Reported as group
Quality
66.25
Promoting interoperability
100
Improvement activities
40
Cost
71.69

Merit-based Incentive Payment System (MIPS)

Final score
76.49 of 100Reported as group
Quality
68.11
Improvement activities
40
Cost
80.1

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Physicians Inc CurrentSince Aug 7, 2017 Accepting new patients
Premier Health Specialists Inc CurrentSince Jun 5, 2023 Accepting new patients
Premier Health Specialists Inc Physician Assistant CurrentSince Jun 5, 2023 Accepting new patients
Miami Valley Hospital Past Accepting new patients
Premier Heart Associates, Inc Past Accepting new patients

Locations

3535 Pentagon Blvd
Ste 330
Beavercreek, OH 45431
Phone (937) 558-3021

2300 Miami Valley Dr
Ste 150
Centerville, OH 45459
Phone (937) 280-8366

1 Wyoming St
Dayton, OH 45409
Phone (937) 208-2636

30 E Apple St
#6258
Dayton, OH 45409
Phone (937) 208-5300

2400 Miami Valley Dr
Dayton, OH 45459
Phone (937) 208-8394

2300 Miami Valley Dr
Ste 350
Dayton, OH 45459
Phone (937) 424-2469

9000 N Main St
Ste 333
Englewood, OH 45415
Phone (937) 832-8400

9000 N Main St
Ste G-36
Englewood, OH 45415
Phone (937) 832-1093

9000 N Main St
Ste G
Englewood, OH 45415

9000 N Main St
Ste 100
Englewood, OH 45415

4940 Cottonville Rd
Jamestown, OH 45335
Phone (937) 298-4417

3535 Southern Blvd
Kettering, OH 45429
Phone (937) 298-1221

3533 Southern Blvd
Ste 2100
Kettering, OH 45429
Phone (937) 293-3486

4403 Far Hills Ave
Kettering, OH 45429
Phone (937) 395-3910

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

4000 Miamisburg Centerville Rd
Miamisburg, OH 45342
Phone (937) 384-8791

1 Medical Center Dr
Middletown, OH 45005
Phone (513) 424-2111

35 Overbrook Dr
Ste 100
Monroe, OH 45050
Phone (513) 539-7356

35 Overbrook Dr
Monroe, OH 45050
Phone (513) 407-6946

360 W Central Ave
Springboro, OH 45066
Phone (937) 208-7100

450 N Hyatt St
Ste 304
Tipp City, OH 45371
Phone (937) 832-4773

3590 Busenbark Rd
Trenton, OH 45067
Phone (513) 869-4600

3130 N County Road 25A
Troy, OH 45373
Phone (937) 440-4000

600 Aviator Ct
Ste 100
Vandalia, OH 45377
Phone (937) 208-7776

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

Organizations & group practices 9

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.

Hospital & facility affiliations 3

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": "1410480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649721600000",
    "number": "1750782496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3533 SOUTHERN BLVD.",
            "address_2": "STE. 2100",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454291267",
            "telephone_number": "937-395-8556",
            "fax_number": "937-395-6376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 SOUTHERN BLVD",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454291221",
            "telephone_number": "937-395-6665",
            "fax_number": "937-395-6668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "OLIVIA",
        "middle_name": "C",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-12",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.004119RX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0110469",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "oroberts603845@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "3535 Southern Blvd",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454291221",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "3535 Southern Blvd",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454291221",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kettering, OH

Sources for this page

Verify at the official NPI Registry.