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Active NPI 1821712316 Individual Practitioner Male Practitioner

Jacob Dougherty , AGACNP-BC

Nurse Practitioner - Gerontology • Centerville, OH

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Jacob Dougherty, AGACNP-BC is a certified Nurse Practitioner - Gerontology practicing in Centerville, OH. With approximately 4 years of clinical experience since graduating from University Of Cincinnati College Of Medicine in 2022, Jacob Dougherty delivers high-quality medical care to the local community at 2400 MIAMI VALLEY DR.

Jacob Dougherty maintains professional affiliations with Rajesh C Patel Md Inc, Kettering Independent Medical Group Inc and accepts Medicare assignment.

Frequently performed procedures and clinical services include initial hospital care with straightforward or low-level medical decision making, if using time, at least, critical care, first, ultrasonic guidance for blood vessel access. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

2400 Miami Valley Dr

Centerville, OH 454594774

Telephone 9374382400
Associated Practice Facility / Clinic

Medicare Profile & Education

Medical School

University Of Cincinnati College Of Medicine

Graduation Year

2022

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Nurse Practitioner - Gerontology in Centerville, OH

Rising Specialist (<5 Yrs)
Practitioner Clinical Experience
4 Yrs -3.5 yrs vs City Avg
City Avg: 7.5 Yrs
State Avg: 7.7 Yrs
Regional Practice Density
4 Specialists

Practicing in Centerville, OH (529 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
62.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Dougherty (4 Years) 4 Yrs
Centerville Specialty Average (7.5 Years) 7.5 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes
14 14 $150.00 $105.40
99291 Critical care, first 30-74 minutes
13 12 $400.00 $172.19
76937 Ultrasonic guidance for blood vessel access
12 12 $50.00 $11.22
36556 Insertion of non-tunneled central venous tube for infusion (5 years or older)
11 11 $350.00 $68.18

Medical Specialties & State Licenses

CMS Verified: 2026-03-11
Nurse Practitioner - Gerontology Primary Specialty

NUCC Taxonomy Code: 363LG0600X

State License OH APRN.CNP.0032076

Definition to come...

Hospital & Practice Group Affiliations

Rajesh C Patel Md Inc

9001 N Main St, Dayton, OH 454151154

Phone: 9378320990

Kettering Independent Medical Group Inc

3095 Dayton Xenia Rd, Dayton, OH 454344311

Phone: 9374584010

Secondary Practice Locations

3095 Dayton Xenia Rd Ste 900

Dayton, OH 454344311

Phone: 9374584010

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

17 Associated Practitioners
Jennifer Wagner

Nurse Practitioner - Acute Care

NPI 1003736984
Heather Davis , NP

Nurse Practitioner - Acute Care

NPI 1013602622

Nurse Practitioner

Jenna Williams , ATC

General Acute Care Hospital

NPI 1053777631

Certified Athletic Trainer

Erin Berberich , ATC

Specialist/Technologist - Athletic Trainer

NPI 1063964062

Certified Athletic Trainer

Emily Sorensen , NP-C

Nurse Practitioner - Family

NPI 1104122696

Nurse Practitioner (Certified)

Alicia Slifer

Nurse Practitioner - Adult Health

NPI 1114305349

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

9 Historical Events
🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) March 11, 2026

Nurse Practitioner (License #APRN.CNP.0032076 in OH)

📍
Updated Business Mailing Address November 03, 2025

Registered at 1 PRESTIGE PL STE 550, MIAMISBURG, OH 453426115 (Tel: 9377621306)

📍
Updated Practice Location December 17, 2022

Registered at 2400 MIAMI VALLEY DR, CENTERVILLE, OH 454594774 (Tel: 9374382400)

NPI Profile Active September 28, 2022

NPI status registered as active in NPPES database

📍
Updated Practice Location September 28, 2022

Registered at 3000 MACK RD, FAIRFIELD, OH 450145335 (Tel: 5138707000)

📍
Updated Business Mailing Address September 28, 2022

Registered at 463 COLUMBUS AVE UNIT 23, LEBANON, OH 450362688

👤
Provider Name / Credentials Updated September 28, 2022

Recorded as JACOB DOUGHERTY, AGACNP-BC

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) September 28, 2022

Nurse Practitioner (License #APRN.CNP.0032076 in OH)

🟢
Initial NPI Registration & Enumeration September 28, 2022

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1821712316
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 28, 2022
Last Update: March 11, 2026
Sole Proprietor: Yes

Mailing Address

1 Prestige Pl Ste 550

Miamisburg, OH 453426115

Phone: 9377621306

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.