Jacob Dougherty, AGACNP-BC

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

APRN.CNP.0032076 Issued in OH

Practice address

2400 Miami Valley Dr
Centerville, OH 45459-4774

Phone

(937) 438-2400

NPI assigned

Sep 28, 2022

Last updated

Mar 11, 2026By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

University of Cincinnati College of Medicine, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kettering Independent Medical Group IncGroup PAC ID 3173710936, 699 clinicians

Rajesh C Patel MD IncGroup PAC ID 2961538467, 25 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Miami Valley Hospital Hospital, Dayton, OH, CCN 360051
• Kettering Health Greene Memorial Hospital, Xenia, OH, CCN 360026
• Atrium Medical Center Hospital, Franklin, OH, CCN 360076

Merit-based Incentive Payment System (MIPS)

Final score

84.31 of 100Reported as group

Quality

79.48

Promoting interoperability

71

Improvement activities

40

Cost

79.87

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jdougherty632981@direct.ketteringhealth.org

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.

• Kettering Independent Medical Group Inc

  • Orthopaedic Surgery Physician
  • Miamisburg, OH
  • NPI 1629387865
  Medicare reassignment Care Compare group NPD
• Rajesh C Patel MD Inc

  dba Dayton Respiratory Center

  • Pulmonary Disease Physician
  • Dayton, OH
  • NPI 1467446369
  Medicare reassignment Care Compare group NPD
• Premier Health Specialists Inc

  • Internal Medicine Physician
  • Moraine, OH
  • NPI 1194958223
  Medicare reassignment NPD
• Premier Health Specialists Inc

  dba Advanced Ankle and Foot Specialists

  • Foot & Ankle Surgery Podiatrist
  • Dayton, OH
  • NPI 1902211287
  NPD
• Rajesh C. Patel, M.D., Inc.

  dba dba Sleep Therapeutics of Ohio, LLC

  • Oxygen Equipment & Supplies (DME)
  • Centerville, OH
  • NPI 1669785572
  NPD

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

• Atrium Medical Center

  • General Acute Care Hospital
  • Franklin, OH
  • NPI 1700950060
  Care Compare affiliation
• Greene Memorial Hospital Inc

  dba Kettering Health Greene Memorial

  • General Acute Care Hospital
  • Xenia, OH
  • NPI 1255317848
  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": "1664323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773187200000",
    "number": "1821712316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PRESTIGE PL STE 550",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453426115",
            "telephone_number": "937-762-1306",
            "fax_number": "937-522-7017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 MIAMI VALLEY DR",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454594774",
            "telephone_number": "937-438-2400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3095 Dayton Xenia Rd Ste 900",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454344311",
            "country_code": "US",
            "telephone_number": "937-458-4010",
            "fax_number": "937-912-0169",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "JACOB",
        "credential": "AGACNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-09-28",
        "last_updated": "2026-03-11",
        "certification_date": "2026-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "OH",
            "license": "APRN.CNP.0032076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jdougherty632981@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "3095 Dayton Xenia Rd Ste 900",
            "city": "Dayton",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454344311",
            "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": "3095 Dayton Xenia Rd Ste 900",
            "city": "Dayton",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454344311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• William Roscoe Dorsey, DO
• Kathleen E Dorsten, IMFT
• Matt Dorweiler
• Amelia Leiann Dotson, LPC
• David J. Doucette, MD
• Emily Dowd, FNP
• Myra Bibb Dowler, PA
• Harold Kenneth Downey Jr., D.C.
• Jeri Downey, FNP
• Kimberly Downs

• Gerontology Nurse Practitioner in Centerville, OH
• Providers in Centerville, OH by specialty
• Gerontology Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2026; 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.