Lydia Helen Nefedov, MSN, AGNP-BC

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

APRN.CNP.0040200 Issued in OH

Practice address

3463 Magic Dr Ste T21
San Antonio, TX 78229-3621

Phone

(210) 614-8101

NPI assigned

Nov 28, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in NV, TX, IN, ND, OH, WI6 enrollments

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 6

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ascension Medical Group-Fox Valley Wisconsin, IncGroup PAC ID 0244142420, 260 clinicians

Kettering Independent Medical Group IncGroup PAC ID 3173710936, 699 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension NE Wisconsin - St Elizabeth Campus Hospital, Appleton, WI, CCN 520009

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lnefedov@direct.iuhealth.org
• Direct secure messaging: lnefedov996132@direct.ketteringhealth.org
• Direct secure messaging: lydianefedov@usoapas.allscriptsdirect.net

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.

• Ascension Medical Group-Fox Valley Wisconsin, Inc

  • Multi-Specialty Clinic/Center
  • Neenah, WI
  • NPI 1730126392
  Medicare reassignment Care Compare group NPD
• Kettering Independent Medical Group Inc

  • Orthopaedic Surgery Physician
  • Miamisburg, OH
  • NPI 1629387865
  Medicare reassignment Care Compare group NPD
• BHS Physicians Network, Inc

  • Family Medicine Physician
  • San Antonio, TX
  • NPI 1598958431
  Medicare reassignment NPD
• Health and Human Services Commission

  • Clinical Neuropsychologist
  • Harlingen, TX
  • NPI 1356414692
  Medicare reassignment NPD
• Post Acute Specialists of Texas PA

  • Geriatric Medicine (Family Medicine) Physician
  • Austin, TX
  • NPI 1942859350

  Acute Care

  Medicare reassignment NPD
• San Antonio Assisting Services, LLC

  • Specialist
  • San Antonio, TX
  • NPI 1043469323
  Medicare reassignment NPD
• Dignity Health

  • Neurological Surgery Physician
  • Henderson, NV
  • NPI 1720358039
  Medicare reassignment NPD
• Indiana University Health Southern Indiana Physicians, LLC

  • Multi-Specialty Clinic/Center
  • Bloomington, IN
  • NPI 1013953983
  Medicare reassignment NPD
• Iu Health Medical Group, LLC

  • General Practice Physician
  • Indianapolis, IN
  • NPI 1326893777
  Medicare reassignment NPD
• Sanford Medical Center Fargo

  • Family Medicine Physician
  • West Fargo, ND
  • NPI 1184917924
  Medicare reassignment NPD
• Michael B Jacobs, M.D., PH.D.

  • Internal Medicine Physician
  • Las Vegas, NV
  • NPI 1053300913
  Medicare reassignment
• BHS Physicians Network, Inc

  • Durable Medical Equipment & Medical Supplies
  • Boerne, TX
  • NPI 1730079286
  NPD

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

• Ascension NE Wisconsin, Inc

  • Ambulatory Surgical Clinic/Center
  • Menasha, WI
  • NPI 1124075536

  Hospital

  Care Compare affiliation
• Ascension NE Wisconsin, Inc

  • General Acute Care Hospital
  • Appleton, WI
  • NPI 1407803638
  Care Compare affiliation

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

{
    "created_epoch": "1480291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773187200000",
    "number": "1902349772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3463 MAGIC DR STE T21",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293621",
            "telephone_number": "210-614-8101"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3533 Southern Blvd Ste 5650",
            "address_purpose": "LOCATION",
            "city": "Kettering",
            "state": "OH",
            "postal_code": "454291263",
            "country_code": "US",
            "telephone_number": "937-294-3611",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NEFEDOV",
        "first_name": "LYDIA",
        "middle_name": "HELEN",
        "credential": "MSN, AGNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-28",
        "last_updated": "2026-03-11",
        "certification_date": "2026-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NV",
            "license": "APRN002369",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "1075580",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IN",
            "license": "71013911A",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "OH",
            "license": "APRN.CNP.0040200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "090540884",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "3533 Southern Blvd Ste 5650",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454291263",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lnefedov996132@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "3533 Southern Blvd Ste 5650",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454291263",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jamie Neelon, MD
• Erin Kimberly Neely, BCBA
• Kirleen Neely, PHD, LPC-S
• Warren F Neely, M.D.
• Nicole S I Neer, DPT
• Laurie A Nega, RN
• Morgan Rae Negaard, DNP, APRN, PMHNP-BC
• Marisa Belen Negley, OTD
• Ciria Negrete, LPC
• Roberto A Negron, MD

• Acute Care Nurse Practitioner in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Acute Care Nurse Practitioner in Texas

• 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.