Individual provider Active NPI

Cristina L Khuth

  • Social Worker
  • Celina, OH
National Provider Identifier
1043785322
Registry record updated Apr 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
S.1903378 Issued in OH
Practice address
4761 State Route 29
Celina, OH 45822-8216
Phone
(419) 584-1000
NPI assigned
Oct 12, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X
Social Worker 104100000X S.1903378 OH Primary

Addresses

Primary practice location

4761 State Route 29
Celina, OH 45822-8216

Mailing address

4761 State Route 29
Celina, OH 45822-8216
Phone (419) 584-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230126001486 OH Practitioner - Clinical Social Worker 2860863065 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2018
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Sequoia Wellness Center LLCGroup PAC ID 3173045010, 2 clinicians
Center for Personal Wellness, LLCGroup PAC ID 6507202256, 6 clinicians
Foundations Behavioral Health Services IncGroup PAC ID 0143204172, 4 clinicians

Practice addresses (Care Compare)

3000 Elida Rd
Suite 2
Lima, OH 45805-1232
Phone (248) 821-2750

4 Eagle Dr
Suite a
Minster, OH 45865-9714
Phone (419) 628-6156

4761 State Route 29
Celina, OH 45822-8216
Phone (419) 584-1000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
S.1903378OHMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Sequoia Wellness Center LLC CurrentSince Dec 31, 2024 Accepting new patients
Center for Personal Wellness, LLC CurrentSince Jan 29, 2024 Accepting new patients
Foundations Behavioral Health Services, Inc. CurrentSince May 16, 2024 Accepting new patients
Michael D. Griffith, PH.D. & Assoc., LLC PastSince Dec 31, 2024 Accepting new patients
JTDM Family Practice LLC PastSince Jan 29, 2024 Accepting new patients

Locations

4761 State Route 29
Celina, OH 45822
Phone (419) 584-1000

3000 Elida Rd
Ste 2
Lima, OH 45805
Phone (248) 821-2750

86 N Hanover St
Minster, OH 45865
Phone (419) 230-5845

4 Eagle Dr
Ste A
Minster, OH 45865
Phone (419) 394-9579

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1539302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619481600000",
    "number": "1043785322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4761 STATE ROUTE 29",
            "city": "CELINA",
            "state": "OH",
            "postal_code": "458228216",
            "telephone_number": "419-584-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4761 STATE ROUTE 29",
            "city": "CELINA",
            "state": "OH",
            "postal_code": "458228216",
            "telephone_number": "419-584-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHUTH",
        "first_name": "CRISTINA",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-12",
        "last_updated": "2021-04-27",
        "certification_date": "2021-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S.1903378",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Celina, OH

Sources for this page

Verify at the official NPI Registry.