NPIMap

Individual provider Active NPI

Shital Pema, DPM

  • Primary Podiatric Medicine Podiatrist
  • Kettering, OH
National Provider Identifier
1780640995
Registry record updated Jul 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X
License
36003246P Issued in OH
Practice address
4441 Far Hills Ave
Kettering, OH 45429-2405
Phone
(937) 298-7351
Fax
(937) 298-9458
NPI assigned
Apr 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Podiatric Medicine Podiatrist 213EP1101X 36003246P OH Primary

Addresses

Primary practice location

4441 Far Hills Ave
Kettering, OH 45429-2405

Mailing address

4441 Far Hills Ave
Kettering, OH 45429-2405
Phone (937) 298-7351

Other identifiers 1

IdentifierTypeStateIssuer
2222080MedicaidOH

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
I20051212000211 OH Practitioner - Podiatry 0143241752 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
New York College of Podiatric Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopedic Associates of Dayton IncGroup PAC ID 0648174979, 8 clinicians

Practice addresses (Care Compare)

7980 N Main St
Dayton, OH 45415-2328
Phone (937) 280-4988

Hospital & facility affiliations

  • Fidelity Health Care Home health agency, Moraine, OH, CCN 367160
  • Bethany Village Home Health Care Home health agency, Dayton, OH, CCN 368343
  • Atrium Medical Center Hospital, Franklin, OH, CCN 360076
  • Miami Valley Hospital Hospital, Dayton, OH, CCN 360051
  • Kettering Health Miamisburg Hospital, Miamisburg, OH, CCN 360239
  • Ohio Valley Surgical Hospital Hospital, Springfield, OH, CCN 360355
  • Kettering Health Dayton Hospital, Dayton, OH, CCN 360133

Merit-based Incentive Payment System (MIPS)

Final score
99.51 of 100Reported as group
Promoting interoperability
98
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue186
Removal of nail tissue16

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
36003246POHMDPrimary Podiatric Medicine Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Cary Copeland DPM Inc Primary Podiatric Medicine CurrentSince Sep 2, 2019 Accepting new patients
Cary Copeland DPM Inc Primary Podiatric Medicine CurrentSince Sep 2, 2019 Accepting new patients

Locations

4260 Glendale Milford Rd
Ste 103
Blue Ash, OH 45242
Phone (513) 769-4408

3731 S Dixie Hwy
Middletown, OH 45005
Phone (513) 423-0672

Interoperability endpoints

  • Direct secure messaging: shitalpema@oad.allscriptsdirect.net

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 and National Provider Directory roles.

Hospital & facility affiliations 7

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": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1499904000000",
    "number": "1780640995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4441 FAR HILLS AVE",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454292405",
            "telephone_number": "937-298-7351",
            "fax_number": "937-298-9458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4441 FAR HILLS AVE",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454292405",
            "telephone_number": "937-298-7351",
            "fax_number": "937-298-9458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEMA",
        "first_name": "SHITAL",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-25",
        "last_updated": "2017-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "OH",
            "license": "36003246P",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2222080",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kettering, OH

Sources for this page

Verify at the official NPI Registry.