NPIMap

Individual provider Active NPI

Lisa Marie Roshetsky Kearns, M.D.

  • Internal Medicine Physician
  • Marysville, OH
National Provider Identifier
1891815320
Registry record updated Jan 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35093936 Issued in OH
Practice address
660 London Ave Ste a
Marysville, OH 43040-1515
Phone
(937) 642-1550
Fax
(937) 578-2821
NPI assigned
Mar 29, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD040679 DC
Internal Medicine Physician 207R00000X 35093936 OH Primary

Addresses

Primary practice location

660 London Ave Ste a
Marysville, OH 43040-1515

Mailing address

660 London Ave Ste a
Marysville, OH 43040-1515
Phone (937) 642-1550

Other identifiers 1

IdentifierTypeStateIssuer
2966401MedicaidOH

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
I20090824000078 OH Practitioner - Internal Medicine 8628122819 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Northeastern Ohio University College of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Union County Physician CorporationGroup PAC ID 1557419173, 105 clinicians

Practice addresses (Care Compare)

660 London Ave
Marysville, OH 43040-1515
Phone (937) 642-1550

Hospital & facility affiliations

  • Summit Orthopaedic Home Care Home health agency, Grandview Heights, OH, CCN 368154
  • Memorial Hospital Hospital, Marysville, OH, CCN 360092
  • Ohio State University State Health System Hospital, Columbus, OH, CCN 360085
  • Mary Rutan Hospital Hospital, Bellefontaine, OH, CCN 360197
  • Dublin Methodist Hospital Hospital, Dublin, OH, CCN 360348

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD040679DCMDInternal Medicine Physician
35093936OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Union County Physician Corporation CurrentSince Dec 20, 2022 Accepting new patients
Union County Physician Corporation Current Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

660 London Ave
Ste A
Marysville, OH 43040
Phone (937) 578-4206

660 London Ave
Marysville, OH 43040
Phone (614) 293-4967

388 Damascus Rd
Marysville, OH 43040
Phone (937) 578-2626

Interoperability endpoints

  • Direct secure messaging: lkearns247531@direct.osumc.edu

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": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672963200000",
    "number": "1891815320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 LONDON AVE STE A",
            "city": "MARYSVILLE",
            "state": "OH",
            "postal_code": "430401515",
            "telephone_number": "937-642-1550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 LONDON AVE STE A",
            "city": "MARYSVILLE",
            "state": "OH",
            "postal_code": "430401515",
            "telephone_number": "937-642-1550",
            "fax_number": "937-578-2821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEARNS",
        "first_name": "LISA",
        "middle_name": "MARIE ROSHETSKY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-29",
        "last_updated": "2023-01-06",
        "certification_date": "2023-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "DC",
            "license": "MD040679",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35093936",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2966401",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marysville, OH

Sources for this page

Verify at the official NPI Registry.