Kelsey Ketchum

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN.CNP.0033883 Issued in OH

Practice address

72 Goldengate Dr
Centerville, OH 45459-4325

Phone

(419) 605-7307

NPI assigned

May 9, 2023

Last updated

Jul 24, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

CG Medical Associates IncGroup PAC ID 6608052196, 171 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

87.23 of 100Reported as group

Quality

83.64

Promoting interoperability

100

Improvement activities

40

Cost

73.78

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• CG Medical Associates Inc

  • Urgent Care Clinic/Center
  • Cincinnati, OH
  • NPI 1982903951
  Medicare reassignment Care Compare group NPD
• Mvhe Inc

  • Family Medicine Physician
  • Moraine, OH
  • NPI 1659504785
  Medicare reassignment NPD
• Mvhe Inc

  dba Middletown Medical Group

  • Internal Medicine Physician
  • Middletown, OH
  • NPI 1497154827
  NPD

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

{
    "created_epoch": "1683590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690156800000",
    "number": "1053001412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72 GOLDENGATE DR",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454594325",
            "telephone_number": "419-605-7307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 GOLDENGATE DR",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454594325",
            "telephone_number": "419-605-7307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETCHUM",
        "first_name": "KELSEY",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-09",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.0033883",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN.474362",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donna Kelley
• Christie Kemper
• Kernan Oral Maxillofacial & Implant Surgery
• Holly L Kershner, RPH
• Michele Kester
• Kettering Medical Center
• Kevin F Sunshein DPM Inc (Sunshein Podiatry)
• Kevin F. Schamel DDS Parkway Dental Inc (Schamel Family Dentistry)
• David W Key, M.D.
• Sophia Samdani Khan, M.D.

• Family Nurse Practitioner in Centerville, OH
• Providers in Centerville, OH by specialty
• Family Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.