Individual provider Active NPI

Katelyn Jule Klosterman

  • Family Medicine Physician
  • Effingham, IL
National Provider Identifier
1003312422
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036.165254 Issued in IL
Practice address
1303 W Evergreen Ave Ste 202
Effingham, IL 62401-1638
Phone
(217) 238-4634
Fax
(217) 342-3402
NPI assigned
Apr 4, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01085288A IN
Family Medicine Physician 207Q00000X 036.165254 IL Primary

Addresses

Primary practice location

1303 W Evergreen Ave Ste 202
Effingham, IL 62401-1638

Mailing address

PO Box 372
Mattoon, IL 61938-0372

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231003001288 IL Practitioner - Family Practice 7517214877 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sarah Bush Lincoln Health CenterGroup PAC ID 5092614867, 411 clinicians

Practice addresses (Care Compare)

1000 Health Ctr Dr
Mattoon, IL 61938-4644

101 Professional PLZ
Mattoon, IL 61938-9252
Phone (217) 238-3730

1303 W Evergreen Ave
Effingham, IL 62401-1638

Hospital & facility affiliations

  • Sarah Bush Lincoln Home Care Home health agency, Charleston, IL, CCN 147594
  • Sarah Bush Lincoln Health Center Hospital, Mattoon, IL, CCN 140189
  • St Anthonys Memorial Hospital Hospital, Effingham, IL, CCN 140032

Merit-based Incentive Payment System (MIPS)

Final score
88.96 of 100Reported as apm
Quality
69.5
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036.165254ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sarah Bush Lincoln Health Center CurrentSince Aug 21, 2023 Accepting new patients
Sarah Bush Lincoln Health Center Current Accepting new patients
Sarah Bush Lincoln Health Center PastSince Sep 24, 2023 Accepting new patients

Locations

1303 W Evergreen Ave
Ste 202
Effingham, IL 62401
Phone (217) 238-4634

101 Professional Plz
Mattoon, IL 61938
Phone (217) 238-3730

1000 Health Center Dr
Mattoon, IL 61938
Phone (217) 258-2389

Interoperability endpoints

  • Direct secure messaging: kklosterman352967@direct-prd.stelizabeth.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1522800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1003312422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 372",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619380372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1303 W EVERGREEN AVE STE 202",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624011638",
            "telephone_number": "217-238-4634",
            "fax_number": "217-342-3402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLOSTERMAN",
        "first_name": "KATELYN",
        "middle_name": "JULE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-04",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01085288A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.165254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Effingham, IL

Sources for this page

Verify at the official NPI Registry.