Individual provider Active NPI

Kaitlyn Oldewurtel, DO

  • Colon & Rectal Surgery Physician
  • Worcester, MA
National Provider Identifier
1043871163
Registry record updated Jun 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
License
1019739 Issued in MA
Practice address
67 Belmont St
Worcester, MA 01605-2657
Phone
(508) 334-8195
Fax
(508) 334-8130
NPI assigned
Jun 28, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Colon & Rectal Surgery Physician 208C00000X 1019739 MA Primary

Addresses

Primary practice location

67 Belmont St
Worcester, MA 01605-2657

Mailing address

PO Box 415348
Boston, MA 02241-5348

Other practice location 1

42 E Laurel Rd Ste 2600
Stratford, NJ 08084-1354
Phone (856) 566-6875

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20240626000789 MA Practitioner - Colorectal Surgery (Proctology) 6406390947
I20250902002019 TX Practitioner - Colorectal Surgery (Proctology) 6406390947 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Colorectal Surgery (Proctology)
Education
Rowan University School of Osteopathic Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

8200 Walnut Hill LN
Dallas, TX 75231-4496
Phone (214) 345-6789

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy27

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1019739MAMDColon & Rectal Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Texas Southwestern Medical Center at Dallas CurrentSince Aug 20, 2025 Accepting new patients
Umass Memorial Medical Group Inc Current Accepting new patients
University of Texas Southwestern Medical Center at Dallas Current Accepting new patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Aug 20, 2025 Accepting new patients
Rowan University School of Osteopathic Medicine Past Accepting new patients

Locations

67 Belmont St
Worcester, MA 01605
Phone (508) 334-8996

55 Lake Ave N
Worcester, MA 01655
Phone 508334100048862

8200 Walnut Hill Ln
Dallas, TX 75231
Phone (214) 345-6148

2201 Inwood Rd
Dallas, TX 75235
Phone (214) 645-2563

12500 Dallas Pkwy
Frisco, TX 75033
Phone (469) 604-9000

3621 22nd St
Ste 400
Lubbock, TX 79410
Phone (806) 791-8484

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

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.

Hospital & facility affiliations 2

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": "1561680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718582400000",
    "number": "1043871163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 415348",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022415348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 BELMONT ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016052657",
            "telephone_number": "508-334-8195",
            "fax_number": "508-334-8130"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "42 E Laurel Rd Ste 2600",
            "address_purpose": "LOCATION",
            "city": "Stratford",
            "state": "NJ",
            "postal_code": "080841354",
            "country_code": "US",
            "telephone_number": "856-566-6875",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OLDEWURTEL",
        "first_name": "KAITLYN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-28",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "MA",
            "license": "1019739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.