Active NPI
Kachema Woodruff
- Social Worker
- Fairborn, OH
National Provider Identifier
1982473468
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- S.2106837
- Practice address
- 188 W Hebble Ave
Fairborn, OH 45324-4960 - Phone
- (937) 754-5911
- NPI assigned
- Dec 26, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | S.2106837 | OH | Primary |
Addresses
Primary practice location
188 W Hebble Ave
Fairborn, OH 45324-4960
Mailing address
120 W Main St
Circleville, OH 43113-1654
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S.2106837 | OH | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Phoenix Group Home, LLC | Past | Accepting new patients | |
| Phoenix Group Home, LLC | Past | Accepting new patients |
Interoperability endpoints
- https://api.qualifacts.org/api/fhir/pathihc/r4/
Organizations & group practices 2
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.
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- NPI 1083146013
-
- Substance Abuse Rehabilitation Facility
- Cincinnati, OH
- NPI 1336654854
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1703548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703548800000",
"number": "1982473468",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 W MAIN ST",
"city": "CIRCLEVILLE",
"state": "OH",
"postal_code": "431131654"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "188 W HEBBLE AVE",
"city": "FAIRBORN",
"state": "OH",
"postal_code": "453244960",
"telephone_number": "937-754-5911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOODRUFF",
"first_name": "KACHEMA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-12-26",
"last_updated": "2023-12-26",
"certification_date": "2023-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "S.2106837",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairborn, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.