Individual provider Active NPI

John M. Duchak III, MD

  • Cardiovascular Disease Physician
  • Dayton, OH
National Provider Identifier
1841269057
Registry record updated Feb 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
35.064642 Issued in OH
Practice address
1126 S Main St
Dayton, OH 45409-2687
Phone
(937) 223-3053
Fax
(937) 463-1765
NPI assigned
Mar 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 35.064642 OH Primary

Addresses

Primary practice location

1126 S Main St
Dayton, OH 45409-2687

Mailing address

4000 Miamisburg Centerville Rd Ste 100
Miamisburg, OH 45342-7615
Phone (937) 866-0637

Other identifiers 2

IdentifierTypeStateIssuer
110077875OtherOHRAILROAD MEDICARE
0952518MedicaidOH

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/
Direct Messaging Address jduchak170515@direct.ketteringhealth.org

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050808000274 OH Practitioner - Cardiovascular Disease (Cardiology) 2264414440 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
University of Toledo College of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kettering Independent Medical Group IncGroup PAC ID 3173710936, 699 clinicians

Practice addresses (Care Compare)

1141 N Monroe Dr
Xenia, OH 45385-1619
Phone (937) 490-2270

1380 E Stroop Rd
Kettering, OH 45429-4926
Phone (937) 293-3486

3535 Pentagon Blvd
Beavercreek, OH 45431-1705

3535 Pentagon Park Blvd
Suite 400
Dayton, OH 45431-1705
Phone (937) 490-2264

4000 Miamisburg Centerville Rd
Miamisburg, OH 45342-7615

4403 Far Hills Ave
Kettering, OH 45429-2405
Phone (937) 433-5309

4441 Far Hills Ave
Kettering, OH 45429-2405
Phone (937) 298-7751

600 W Main St
Troy, OH 45373-3384

7677 Yankee St
Suite 140
Dayton, OH 45459-3475
Phone (866) 224-9472

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.34 of 100Reported as group
Quality
63.67
Promoting interoperability
100
Improvement activities
40
Cost
74.14

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35.064642OHMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kettering Independent Medical Group Inc Cardiovascular Disease CurrentSince Dec 29, 2022 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Professional Readers Group, Inc Past Accepting new patients

Locations

68 Darst Rd
Dayton, OH 45440
Phone (937) 458-6700

812 Central Ave
Greenville, OH 45331
Phone (937) 548-1522

1380 E Stroop Rd
Kettering, OH 45429
Phone (937) 293-3486

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

4000 Miamisburg Centerville Rd
Ste 100
Miamisburg, OH 45342
Phone (937) 643-9939

70 Weller Dr
Tipp City, OH 45371
Phone (937) 298-4417

7677 Yankee St
Ste 140
Washington Township, OH 45459
Phone (866) 224-9472

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 4

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": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612137600000",
    "number": "1841269057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 MIAMISBURG CENTERVILLE RD STE 100",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453427615",
            "telephone_number": "937-866-0637",
            "fax_number": "937-866-6713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1126 S MAIN ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454092687",
            "telephone_number": "937-223-3053",
            "fax_number": "937-463-1765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUCHAK",
        "first_name": "JOHN",
        "middle_name": "M.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-17",
        "last_updated": "2021-02-01",
        "certification_date": "2021-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OH",
            "license": "35.064642",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110077875",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0952518",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "4000 Miamisburg Centerville Rd Ste 100",
            "city": "Miamisburg",
            "state": "OH",
            "country_code": "US",
            "postal_code": "453427615",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jduchak170515@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "4000 Miamisburg Centerville Rd Ste 100",
            "city": "Miamisburg",
            "state": "OH",
            "country_code": "US",
            "postal_code": "453427615",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.