Ni Ketut Kumala Dewi Hariadi
NPI 1114404159ActiveIndividual· Nurse Practitioner· Independence, OH
Nurse Practitioner with Cleveland Clinic, practicing in Independence, Ohio. Their prescriptions cost Medicare Part D more than their services did: $223,714 for 4,859 claims, against $24,683 paid for services in 2024. Lists Akron General Medical Center and 3 other hospitals as hospital affiliations.
Overview
| NPI | 1114404159 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Sole proprietor | No |
| NPI issued | Jul 23, 2018 |
| Last updated in NPPES | Jul 23, 2018 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Nurse Practitioner Primary | 363L00000X | AG07180050 | OH |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Nurse Practitioner (OH) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 373 |
|---|---|
| Services billed | 793 across 15 procedure codes |
| Paid by Medicare | $24,683 |
Part D prescriptions in 2024
| Prescriptions (claims) | 4,859 · 11,118 30-day fills |
|---|---|
| Patients | 1,148 |
| Total drug cost | $223,714 |
| Generic share | 92% of claims |
Education and affiliations
| Graduation year | 2018 |
|---|---|
| Medicare specialty | Nurse Practitioner |
| Telehealth | Offers telehealth |
Medical group
- Cleveland ClinicCleveland, OH · 7,090 clinicians
Hospital affiliations
- Akron General Medical CenterAkron, OH
- Cleveland ClinicCleveland, OH
- Marymount HospitalGarfield Heights, OH
- Medina HospitalMedina, OH
Other facilities
- Cleveland Clinic Home CareHome health agency · Independence, OH
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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