Individual provider Active NPI

Paul Jutte, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Miamisburg, OH
National Provider Identifier
1114540317
Registry record updated Aug 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
026687 Issued in OH
Practice address
9049 Springboro Pike Ste a
Miamisburg, OH 45342-5057
Phone
(937) 759-0545
Fax
(937) 759-0549
NPI assigned
May 21, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 026687 OH Primary

Addresses

Primary practice location

9049 Springboro Pike Ste a
Miamisburg, OH 45342-5057

Mailing address

9049 Springboro Pike Ste a
Miamisburg, OH 45342-5057
Phone (937) 759-0545

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: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210831003062 OH Practitioner - Nurse Practitioner 4082010061 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Woodstream WellnessGroup PAC ID 8527462506, 55 clinicians

Practice addresses (Care Compare)

9049 Springboro Pike
Miamisburg, OH 45342-4926
Phone (937) 759-0545

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
026687OHMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
WS Wellness LLC Psychiatric/Mental Health CurrentSince May 30, 2021 Accepting new patients

Locations

1911 Old Fairfield Rd
Ste 310
Beavercreek, OH 45432
Phone (937) 759-0545

9049 Springboro Pike
Miamisburg, OH 45342
Phone (937) 759-0545

9049 Springboro Pike
Ste A
Miamisburg, OH 45342
Phone (937) 759-0545

Organizations & group practices 2

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": "1590019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692748800000",
    "number": "1114540317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9049 SPRINGBORO PIKE STE A",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453425057",
            "telephone_number": "937-759-0545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9049 SPRINGBORO PIKE STE A",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453425057",
            "telephone_number": "937-759-0545",
            "fax_number": "937-759-0549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUTTE",
        "first_name": "PAUL",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-21",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "026687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miamisburg, OH

Sources for this page

Verify at the official NPI Registry.