JACOB DOUGHERTY AGACNP-BC
NPI 1821712316
Nurse Practitioner - Gerontology in Centerville, OH

Q: What is Jacob Dougherty's NPI number?

The NPI number for Jacob Dougherty is 1821712316. It was assigned to this individual provider in the NPPES registry on September 28, 2022.

Q: What is Jacob Dougherty's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Gerontology, with taxonomy code 363LG0600X.

Q: When was this NPI record last updated?

The NPPES record for Jacob Dougherty was last updated on March 11, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since September 28, 2022PECOS EnrolledAccepts Medicare Assignment

2400 MIAMI VALLEY DR, CENTERVILLE, OH 45459(937) 438-2400 Get Directions Write a Review

NPPES record last updated: March 11, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Mar 11, 2026, Nov 3, 2025, Dec 17, 2022 and 1 more (4 updates tracked since 2022).

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About Jacob Dougherty Agacnp-bc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACOB DOUGHERTY AGACNP-BC (NPI 1821712316) is an individual gerontology provider in Centerville, Ohio, licensed in Ohio (APRN.CNP.0032076) and active in the NPI registry since September 2022. He is enrolled in Medicare PECOS, is affiliated with Kettering Health Greene Memorial, and maintains a secondary practice location in Dayton.

NPPES Registry Identity

NPI1821712316

Entity TypeIndividualMale

Primary Taxonomy363LG0600X

Provider Legal NameJACOB DOUGHERTYCredential: AGACNP-BC

Location Address2400 MIAMI VALLEY DRCenterville, OH 45459-4774

Mailing Address1 Prestige Pl Ste 550Miamisburg, OH 45342-6115 · (937) 762-1306 · Fax (937) 522-7017

Phone(937) 438-2400

Sole ProprietorYes

Medical School CMSUniversity Of Cincinnati College Of MedicineGraduated 2022

Enumeration DateSeptember 28, 2022

Last NPPES UpdateMarch 11, 20264 updates tracked since enumeration

NPPES CertifiedMarch 11, 2026

✔ NPI 1821712316 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · GerontologyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LG0600X

License✔ Licensed in OH · APRN.CNP.0032076

2400 MIAMI VALLEY DR, Centerville, OH 45459

Open in Google Maps ↗

Secondary Practice Location 1

Location 13095 Dayton Xenia Rd Ste 900Dayton, OH 45434-4311 · Phone (937) 458-4010 · Fax (937) 912-0169

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, CareSource, MedMutual and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jacob Dougherty Agacnp-bc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2163894171

PECOS Enrollment IDI20230220001749

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Jacob Dougherty reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Premier Health Specialists Inc

Same address

Sports Medicine

2350 MIAMI VALLEY DR, STE 320
Dayton, OH 45459

Reassigned Medicare billing, Ohio enrollment
812 clinicians in this Medicare group

NPI 1326316993 (937) 438-4477

Kettering Independent Medical Group Inc

6.2 mi

Orthopaedic Surgery

1 PRESTIGE PL, SUITE 910
Miamisburg, OH 45342

Reassigned Medicare billing, Ohio enrollment
984 clinicians in this Medicare group

NPI 1629387865 (937) 762-1629

Rajesh C Patel MD Inc

16 mi

Pulmonary Disease

9001 N MAIN ST, SUITE A
Dayton, OH 45415

Reassigned Medicare billing, Ohio enrollment
43 clinicians in this Medicare group

NPI 1467446369 (937) 832-0990

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 4

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222

Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.

14 services14 patients

Critical care, first 30-74 minutes 99291

Critical care involves immediate and constant attention by a team of specially-trained health professionals. It's for patients with life-threatening conditions, requiring first 30-74 minutes of intense monitoring and treatment.

13 services12 patients

Ultrasonic guidance for blood vessel access 76937

Ultrasonic guidance for blood vessel access is a medical procedure where sound waves are used to create images of your blood vessels. This helps doctors to accurately locate and access the vessels for treatments or tests, ensuring safety and precision.

12 services12 patients

Insertion of non-tunneled central venous tube for infusion (5 years or older) 36556

This procedure involves placing a thin tube into a large vein, usually in the neck or chest, to administer medication or fluids. It's done under local anesthesia to minimize discomfort. It's a standard, safe procedure for individuals aged 5 and above.

11 services11 patients

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Kettering Health Greene Memorial

Acute Care Hospitals · Xenia, OH

OwnershipVoluntary non-profit - Private

CMS Certification Number360026

Location1141 North Monroe DriveXenia, OH 45385 · Greene County

Emergency services

Miami Valley Hospital

Acute Care Hospitals · Dayton, OH

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number360051

LocationOne Wyoming StreetDayton, OH 45409 · Montgomery County

Emergency services Birthing friendly

Atrium Medical Center

Acute Care Hospitals · Franklin, OH

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number360076

LocationOne Medical Center DriveFranklin, OH 45005 · Warren County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 45459 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$84.72 typical visit price

range $54.34 – $166.65

Typical copayment $21.18 (range $13.58 – $41.66)

Most-billed visit code 99203

Established Patient

$96.44 typical visit price

range $17.10 – $135.40

Typical copayment $24.11 (range $4.27 – $33.85)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JENNIFER M WAGNER

Nurse Practitioner (Acute Care)

2400 MIAMI VALLEY DR
CENTERVILLE, OH 45459

Montgomery County (937) 208-8394

HEATHER DAVIS NP

Nurse Practitioner (Acute Care)

2400 MIAMI VALLEY DR
CENTERVILLE, OH 45459

Montgomery County (937) 438-2400

LUCAS POLLEY

Specialist/Technologist (Athletic Trainer)

2400 MIAMI VALLEY DR, SPORTS MEDICINE CETER
CENTERVILLE, OH 45459

Montgomery County (937) 876-9833

LINDSEY R BOWEN PA

Physician Assistant

2400 MIAMI VALLEY DR
CENTERVILLE, OH 45459

Montgomery County (937) 208-8394

JODI DIEDRICH AT, ATC

Specialist/Technologist (Athletic Trainer)

2400 MIAMI VALLEY DR
CENTERVILLE, OH 45459

Montgomery County (920) 838-3359

JENNA WILLIAMS ATC

General Acute Care Hospital

2400 MIAMI VALLEY DR
CENTERVILLE, OH 45459

Montgomery County (937) 438-2400

MISS ERIN BERBERICH ATC

Specialist/Technologist (Athletic Trainer)

2400 MIAMI VALLEY DR
CENTERVILLE, OH 45459

Montgomery County (937) 438-2400

MRS. EMILY P SORENSEN NP-C

Nurse Practitioner (Family)

2400 MIAMI VALLEY DR
CENTERVILLE, OH 45459

Montgomery County (937) 438-2400

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacob Dougherty's NPI number?

The NPI number for Jacob Dougherty is 1821712316. It was assigned to this individual provider in the NPPES registry on September 28, 2022.

Where is Jacob Dougherty located?

Jacob Dougherty practices at 2400 Miami Valley Dr, Centerville, OH 45459. The listed phone number is (937) 438-2400.

What is Jacob Dougherty's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Gerontology, with taxonomy code 363LG0600X.

Is Jacob Dougherty enrolled in Medicare?

Yes. Jacob Dougherty is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Jacob Dougherty's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jacob Dougherty reassigns Medicare benefits to 3 organizations: Premier Health Specialists Inc (Dayton, OH), Kettering Independent Medical Group Inc (Miamisburg, OH) and Rajesh C Patel MD Inc (Dayton, OH). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jacob Dougherty's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Jacob Dougherty accept?

Health plans from Anthem Blue Cross and Blue Shield, CareSource, MedMutual, Molina Healthcare and Oscar Health Insurance and 1 other insurer list Jacob Dougherty as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Jacob Dougherty affiliated with any hospitals?

According to CMS data, Jacob Dougherty is affiliated with Kettering Health Greene Memorial, Miami Valley Hospital and Atrium Medical Center.

When was this NPI record last updated?

The NPPES record for Jacob Dougherty was last updated on March 11, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.