Individual provider Active NPI

Kayla Wynsma, AGNP

  • Gerontology Nurse Practitioner
  • Crown Point, IN
National Provider Identifier
1164880944
Registry record updated Jul 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
71006398A Issued in IN
Practice address
300 N Main St Ste D
Crown Point, IN 46307-3281
Phone
(219) 663-4888
Fax
(219) 663-4877
NPI assigned
Feb 8, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 71006398A IN Primary
Registered Nurse 163W00000X 28216356A IN

Addresses

Primary practice location

300 N Main St Ste D
Crown Point, IN 46307-3281

Mailing address

300 N Main St Ste D
Crown Point, IN 46307-3281
Phone (219) 663-4888

Other identifiers 1

IdentifierTypeStateIssuer
201377950MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20160812000433 IN Practitioner - Nurse Practitioner 0840584934 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aceso Visiting Physicians and Geriatric Care Inc.Group PAC ID 9133344708, 17 clinicians

Practice addresses (Care Compare)

300 N Main St
Suite D
Crown Point, IN 46307-3281
Phone (219) 663-4888

Hospital & facility affiliations

  • Franciscan Health Crown Point Hospital, Crown Point, IN, CCN 150126

Merit-based Incentive Payment System (MIPS)

Final score
71.72 of 100Reported as individual
Quality
40
Improvement activities
40
Cost
52.42

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
71006398AINMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Aceso Visiting Physicians and Geriatric Care Inc. CurrentSince Aug 1, 2021 Accepting new patients

Locations

300 N Main St
Ste D
Crown Point, IN 46307
Phone (219) 663-4877

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 1

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 1

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": "1454889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658966400000",
    "number": "1164880944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 N MAIN ST STE D",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463073281",
            "telephone_number": "219-663-4888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 N MAIN ST STE D",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463073281",
            "telephone_number": "219-663-4888",
            "fax_number": "219-663-4877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNSMA",
        "first_name": "KAYLA",
        "credential": "AGNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-08",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IN",
            "license": "71006398A",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28216356A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201377950",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crown Point, IN

Sources for this page

Verify at the official NPI Registry.