Individual provider Active NPI

Hetal Desai, PA-C

  • Physician Assistant
  • Kettering, OH
National Provider Identifier
1942461702
Registry record updated Dec 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.002248RX Issued in OH
Practice address
3700 Southern Blvd Ste 401
Kettering, OH 45429
Phone
(855) 500-2873
Fax
(937) 281-3913
NPI assigned
Jun 24, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 2248 OH
Physician Assistant 363A00000X 50.002248RX OH Primary

Addresses

Primary practice location

3700 Southern Blvd Ste 401
Kettering, OH 45429

Mailing address

1 Prestige PL Ste 550
Miamisburg, OH 45342-6115
Phone (937) 762-1305

Other identifiers 1

IdentifierTypeStateIssuer
0110093MedicaidOH

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address hdesai169532@direct.ketteringhealth.org
FHIR URL https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080728000485 OH Practitioner - Physician Assistant 5496829293 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
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)

3535 Pentagon Blvd
Beavercreek, OH 45431-1705

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

3535 Southern Blvd
Kettering, OH 45429-1221
Phone (937) 395-8646

3700 Southern Blvd
Kettering, OH 45429-1265

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

Hospital & facility affiliations

  • Soin Medical Center Hospital, Beaver Creek, OH, CCN 360360
  • Kettering Health Main Campus Hospital, Kettering, OH, CCN 360079
  • Kettering Health Dayton Hospital, Dayton, OH, CCN 360133

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
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2248OHMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Physicians Inc CurrentSince Sep 1, 2014 Accepting new patients
Alliance Physicians Inc CurrentSince Sep 1, 2014 Accepting new patients

Locations

3535 Pentagon Blvd
Ste 400
Beavercreek, OH 45431
Phone (855) 500-2873

3700 Southern Blvd
Ste 401
Kettering, OH 45429
Phone (855) 500-2873

3535 Southern Blvd
Kettering, OH 45429
Phone (937) 298-1221

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

3533 Southern Blvd
Ste 5800
Kettering, OH 45429
Phone (937) 439-3600

4000 Miamisburg Centerville Rd
Ste 405
Miamisburg, OH 45342
Phone (937) 439-3600

1 Prestige Pl
Ste 550
Miamisburg, OH 45342
Phone (937) 752-2306

600 W Main St
Ste 130
Troy, OH 45373
Phone (855) 500-2873

1625 S Alex Rd
West Carrollton, OH 45449
Phone (937) 865-0534

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 3

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": "1214265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606953600000",
    "number": "1942461702",
    "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": "937-762-1305",
            "fax_number": "937-522-7513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 SOUTHERN BLVD STE 401",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "45429",
            "telephone_number": "855-500-2873",
            "fax_number": "937-281-3913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESAI",
        "first_name": "HETAL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-24",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OH",
            "license": "2248",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.002248RX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0110093",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hdesai169532@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "3700 Southern Blvd Ste 401",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "45429",
            "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": "3700 Southern Blvd Ste 401",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "45429",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kettering, OH

Sources for this page

Verify at the official NPI Registry.