JACOB DOUGHERTY (AGACNP-BC) – Acute Care Nurse Practitioner, NPI 1821712316
Acute Care Nurse Practitioner
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
14,984 NURSE PRACTITIONER in OH
Provider Addresses for JACOB DOUGHERTY (AGACNP-BC)
3095 Dayton Xenia Rd Ste 90220
Dayton, OH 454344305
Phone: (937) 458-4010
Fax: (937) 912-0169
Type: Location
1 PRESTIGE PL STE 550
MIAMISBURG, OH 453426115
Phone: (937) 762-1306
Fax: (937) 522-7017
Type: Mailing
2400 MIAMI VALLEY DR
CENTERVILLE, OH 454594774
Phone: (937) 438-2400
Type: Location
3095 Dayton Xenia Rd Ste 900
Dayton, OH 454344311
Phone: (937) 458-4010
Fax: (937) 912-0169
Type: Location
463 COLUMBUS AVE UNIT 23
LEBANON, OH 450362688
Phone:
Type: Mailing
3000 MACK RD
FAIRFIELD, OH 450145335
Phone: (513) 870-7000
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2023-02-20
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20230220001749 | I | Nurse Practitioner | OH | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 45434)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Geriatric Medicine, Hematology/Oncology | IL | |
| Nurse Practitioner | OH | |
| Hematology/Oncology, Internal Medicine | OH | |
| Radiation Oncology | OH | |
| Nurse Practitioner | OH | |
| O B S T E T R I C S/ G Y N E C O L O G Y | OH | |
| Orthopedic Surgery | OH | |
| Pulmonary Disease, Critical Care (Intensivists), Sleep Medicine | OH | |
| Physician Assistant | OH | |
| Hospitalist, Emergency Medicine | OH |
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