Active NPI 1114404159 Individual Practitioner Female Practitioner

Ni Ketut Kumala Dewi Hariadi

Nurse Practitioner • Independence, OH

✓ Accepts Medicare Assignment Telehealth Available

Professional Overview & Biography Verified Profile Summary

Ni Ketut Hariadi is a certified Nurse Practitioner practicing in Independence, OH. With approximately 8 years of clinical experience since completing medical education in 2018, Ni Ketut Hariadi delivers high-quality medical care to the local community at 5001 ROCKSIDE RD.

Ni Ketut Hariadi is affiliated with Cleveland Clinic and accepts Medicare assignment . Telehealth and virtual consultation options are available for eligible patients.

Frequently performed procedures and clinical services include established patient outpatient office visit, visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's, annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

5001 Rockside Rd

Independence, OH 441312172

Telephone 2169864000

Associated Practice Facility / Clinic

🏢 Cleveland Clinic Foundation Facility NPI 1326144890

Medicare Profile & Education

Medical School

Other

Graduation Year

2018

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

Telehealth Services Available

Specialty Benchmarks & Practice Insights

Comparative analytics for Nurse Practitioner in Independence, OH

Experienced Practitioner (5-10 Yrs)

Practitioner Clinical Experience

8 Yrs -1.9 yrs vs City Avg

City Avg: 9.9 Yrs

State Avg: 9.8 Yrs

Regional Practice Density

21 Specialists

Practicing in Independence, OH (4294 Statewide)

Telehealth Adoption Rate

28.6% Regional Adoption

✓ Offers Virtual Consultations

Medicare Pricing Discount

90.1% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Hariadi (8 Years) 8 Yrs

Independence Specialty Average (9.9 Years) 9.9 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	401	292	$624.00	$65.28
G2211 Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's	115	100	$140.00	$13.32
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	103	103	$624.00	$49.13
G0444 Annual depression screening, 5 to 15 minutes	78	78	$77.00	$7.27
99213 Established patient office or other outpatient visit, typically 15 minutes	62	62	$423.00	$52.54

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	400	266	$419.00	$63.43
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	70	70	$450.00	$43.56
G0444 Annual depression screening, 5 to 15 minutes	50	50	$65.00	$7.44
99213 Established patient office or other outpatient visit, typically 15 minutes	42	40	$272.00	$41.05
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	13	12	$113.08	$40.71

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	372	234	$381.00	$63.93
99213 Established patient office or other outpatient visit, typically 15 minutes	90	77	$247.00	$56.77
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	61	61	$409.00	$39.10
G0444 Annual depression screening, 5 to 15 minutes	21	21	$59.00	$7.65
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	19	18	$100.32	$40.44

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	247	188	$370.00	$55.22
99213 Established patient office or other outpatient visit, typically 15 minutes	109	91	$239.94	$38.97
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	39	39	$397.00	$109.36
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	20	20	$100.15	$19.03

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	142	135	$359.00	$43.51
99213 Established patient office or other outpatient visit, typically 15 minutes	96	84	$232.78	$30.24
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	29	29	$385.00	$95.11
99442 Telephone medical discussion with physician, 11-20 minutes	25	25	$150.44	$43.16
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	24	24	$98.88	$14.19
99441 Telephone medical discussion with physician, 5-10 minutes	13	13	$77.31	$21.84

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	175	156	$349.00	$44.54
99213 Established patient office or other outpatient visit, typically 15 minutes	119	111	$226.00	$26.78

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	21	19	$339.00	$65.31

Medical Specialties & State Licenses

Nurse Practitioner Primary Specialty

NUCC Taxonomy Code: 363L00000X

State License OH AG07180050

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Hospital & Practice Group Affiliations

Cleveland Clinic

9500 Euclid Ave, Cleveland, OH 441950001

Phone: 2164442200

Practice Associates & Co-Workers

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

40 Associated Practitioners

Elizabeth Khacherian , FNP-C

Nurse Practitioner - Adult Health

NPI 1013735588

Family Nurse Practitioner (Certified)

Lindsay Fox , PA-C

Physician Assistant - Surgical

NPI 1023262490

Physician Assistant (Certified)

Dr. Elizabeth Cooper , AuD

Audiologist

NPI 1023396793

Doctor of Audiology

Dr. Brianna Bockman Wu , MD

Internal Medicine

NPI 1073192233

Doctor of Medicine (M.D.)

Dr. Michael Khabbaza , DO

Internal Medicine

NPI 1114421658

Doctor of Osteopathic Medicine (D.O.)

Dr. Stephanie Clough , MD

Internal Medicine - Pulmonary Disease

NPI 1144457227

Doctor of Medicine (M.D.)

Career & Practice History Timeline

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

6 Historical Events

✅

NPI Profile Active July 23, 2018

NPI status registered as active in NPPES database

📍

Updated Practice Location July 23, 2018

Registered at 5001 ROCKSIDE RD, INDEPENDENCE, OH 441312172 (Tel: 2169864000)

📍

Updated Business Mailing Address July 23, 2018

Registered at 9000 MOSS POINTE CIR, OLMSTED TWP, OH 441388168 (Tel: 2162583660)

👤

Provider Name / Credentials Updated July 23, 2018

Recorded as NI KETUT HARIADI

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) July 23, 2018

Nurse Practitioner (License #AG07180050 in OH)

🟢

Initial NPI Registration & Enumeration July 23, 2018

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: 1114404159

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: July 23, 2018

Last Update: July 23, 2018

Sole Proprietor: No

Update or Correct Profile

Mailing Address

9000 Moss Pointe Cir

Olmsted Twp, OH 441388168

Phone: 2162583660

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.