Ivan Elises, APRN-CNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN.CNP.0027227 Issued in OH

Practice address

5348 Lamme Rd
Moraine, OH 45439-3215

Phone

(937) 534-4651

Fax

(937) 522-8799

NPI assigned

May 23, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Kettering Independent Medical Group IncGroup PAC ID 3173710936, 699 clinicians

Practice addresses (Care Compare)

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

Medicare enrollment (NPD)

Enrolled

State licenses

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, 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
• Alliance Physicians Inc

  dba Kettering Health Medical Group

  • Family Medicine Physician
  • Kettering, OH
  • NPI 1437125572

  Psychiatry

  Medicare reassignment NPD
• Alliance Physicians Inc

  dba Kettering Behavioral Medicine Center

  • Psychiatry Physician
  • Moraine, OH
  • NPI 1780852228
  NPD

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

{
    "created_epoch": "1558569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610409600000",
    "number": "1891352910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5348 LAMME RD",
            "city": "MORAINE",
            "state": "OH",
            "postal_code": "454393215",
            "telephone_number": "937-534-4651",
            "fax_number": "937-522-8799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5348 LAMME RD",
            "city": "MORAINE",
            "state": "OH",
            "postal_code": "454393215",
            "telephone_number": "937-534-4651",
            "fax_number": "937-522-8799"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1411 N Fairfield Rd",
            "address_purpose": "LOCATION",
            "city": "Beavercreek",
            "state": "OH",
            "postal_code": "454322637",
            "country_code": "US",
            "telephone_number": "937-426-2686",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELISES",
        "first_name": "IVAN",
        "credential": "APRN-CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-23",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "OH",
            "license": "RN.367625",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "APRN.CNP.0027227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ielises665862@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "5348 Lamme Rd",
            "city": "Moraine",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454393215",
            "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": "5348 Lamme Rd",
            "city": "Moraine",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454393215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Deanna Edgemon
• Kyle Edgin
• Leah Kathryn Edmonson, LCDC III
• Yolanda Edwards, RN
• Melissa Caitlin Elchison
• Elizabeth Elliott, QMHS
• Claire Ellis
• James Francis Elsinger
• Joshua P Englefield, DSW, LISW-S
• Tyler Jay English, BA

• Psychiatric/Mental Health Nurse Practitioner in Moraine, OH
• Providers in Moraine, OH by specialty
• Psychiatric/Mental Health Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 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.