Organization Active NPI

Karl G. Rose M.D., Inc.

  • Family Medicine Physician
  • Kettering, OH
National Provider Identifier
1760040315
Registry record updated Aug 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
KARL G. ROSE M.D., INC.
Practice address
3017 Wilmington Pike
Kettering, OH 45429-4075
Phone
(937) 294-2555
Fax
(937) 294-3211
NPI assigned
May 30, 2019
Last updated
Aug 1, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2019

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

Authorized official

Name
Dr. Karl Rose, MDNPI 1235136029
Title
Owner
Phone
(937) 294-2555

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

3017 Wilmington Pike
Kettering, OH 45429-4075

Mailing address

PO Box 292305
Kettering, OH 45429-0305
Phone (937) 294-2555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190731002260 OH Part B Supplier - Clinic/Group Practice 4082940820 Receives reassigned benefits from 1 practitioner
Practice locations: Dayton, OH

National Provider Directory

National Provider Directory

Locations

3017 Wilmington Pike
Kettering, OH 45429
Phone (937) 294-2555

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1559174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564617600000",
    "number": "1760040315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 292305",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454290305",
            "telephone_number": "937-294-2555",
            "fax_number": "937-294-3211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3017 WILMINGTON PIKE",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454294075",
            "telephone_number": "937-294-2555",
            "fax_number": "937-294-3211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KARL G. ROSE M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-30",
        "last_updated": "2019-08-01",
        "status": "A",
        "authorized_official_last_name": "ROSE",
        "authorized_official_first_name": "KARL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "937-294-2555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kettering, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.