Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jacob A Nysather, DO

Individual provider Internal Medicine Physician · NPI 1407376312

Jacob A Nysather, DO is a Nephrology in Montgomery, Ohio. Graduated from Lincoln Mem Univ, Debusk Col of Osteopathic Med in 2017, 9 years ago. Practices with Children's Hospital Medical Center, a 716-clinician group, works from 3 locations, accepts Medicare assignment and offers telehealth. Licensed in Ohio and Virginia.

Years since qualifying
9
Trained at
Lincoln Mem Univ, Debusk Col of Osteopathic Med
Licensed in
OH, VA
In the registry since
2017
Specialties on file
3
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

9275 Montgomery Rd
Montgomery, OH 45242-7779
Phone: (513) 475-8525
Fax: (513) 936-4511
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 375 Dixmyth Ave, Cincinnati, OH 45220-2475 — (513) 865-2246
  • 10500 Montgomery Rd, Montgomery, OH 45242-4402 — (513) 865-5552

Specialties & licences

Nephrology Physician (primary) Taxonomy 207RN0300X · Licence 34.015521 (OH)
Internal Medicine Physician Taxonomy 207R00000X · Licence 0116030769 (VA)
Hospitalist Physician Taxonomy 208M00000X · Licence 34.015521 (OH)

Record details

NPI number1407376312
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorYes
NPI enumeratedJune 21, 2017
Last updated in NPPESMarch 6, 2023
Certification dateMarch 6, 2023
Mailing addressPo Box 636256, Cincinnati, OH 45263-6256

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNEPHROLOGY
Medical schoolLINCOLN MEM UNIV, DEBUSK COL OF OSTEOPATHIC MED
Graduated 2017 (9 years in practice)
Group practice Children'S Hospital Medical Center — 716 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

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