Nicole Wentworth, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35.135818 Issued in OH

Practice address

2510 Commons Blvd Ste 160
Beavercreek, OH 45431-3834

Phone

(937) 426-0049

Fax

(937) 431-8140

NPI assigned

Jun 6, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Nicole Umanoff Former name

Electronic endpoints 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Albany Medical College of Union University, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Alliance Physicians IncGroup PAC ID 0840104360, 314 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kettering Homecare Home health agency, Kettering, OH, CCN 367778
• Kettering Health Dayton Hospital, Dayton, OH, CCN 360133
• Soin Medical Center Hospital, Beaver Creek, OH, CCN 360360
• Kettering Health Main Campus Hospital, Kettering, OH, CCN 360079
• Miami Valley Hospital Hospital, Dayton, OH, CCN 360051
• Kettering Health Greene Memorial Hospital, Xenia, OH, CCN 360026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Alliance Physicians Inc

  • Family Medicine Physician
  • Kettering, OH
  • NPI 1437125572
  Medicare reassignment Care Compare group NPD
• Alliance Physicians, Inc.

  • Vascular Surgery Physician
  • Fairfield, OH
  • NPI 1235554650
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Alternate Solutions Homecare of Dayton, LLC

  • Home Health Agency
  • Kettering, OH
  • NPI 1639195332
  Care Compare affiliation
• Beavercreek Medical Center

  • General Acute Care Hospital
  • Beavercreek, OH
  • NPI 1760764849
  Care Compare affiliation
• Dayton Osteopathic Hospital

  • General Acute Care Hospital
  • Dayton, OH
  • NPI 1053339507
  Care Compare affiliation
• Greene Memorial Hospital Inc

  • General Acute Care Hospital
  • Xenia, OH
  • NPI 1255317848
  Care Compare affiliation
• Kettering Medical Center

  • General Acute Care Hospital
  • Kettering, OH
  • NPI 1043233984
  Care Compare affiliation
• Miami Valley Hospital

  • General Acute Care Hospital
  • Dayton, OH
  • NPI 1073688354
  Care Compare affiliation

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

{
    "created_epoch": "1465171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626739200000",
    "number": "1801245402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2510 COMMONS BLVD STE 160",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454313834",
            "telephone_number": "937-426-0049",
            "fax_number": "937-431-8140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2510 COMMONS BLVD STE 160",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454313834",
            "telephone_number": "937-426-0049",
            "fax_number": "937-431-8140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENTWORTH",
        "first_name": "NICOLE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-06",
        "last_updated": "2021-07-20",
        "certification_date": "2021-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.135818",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0363274",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "numanoff665707@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "2510 Commons Blvd Ste 160",
            "city": "Beavercreek",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454313834",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "2510 Commons Blvd Ste 160",
            "city": "Beavercreek",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454313834",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "UMANOFF",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Anthony W Weiland, PHARMD RPH
• Mary Ellen Weimer, M.D.
• Christina Weir Thorpe
• Aaron Thomas Welly, ACNP-AG
• Clarissa Wentworth
• West Point Optical Group
• David A Westbrock, MD
• Brian Christopher Westcott, APRN CNP
• Western Ohio Sedation Associates, LLC
• Estella J Wetzel, FNP-C

• Family Medicine Physician in Beavercreek, OH
• Providers in Beavercreek, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.