Individual provider Active NPI

Kyle Stahlbaum, PA-C

  • Physician Assistant
  • Cincinnati, OH
National Provider Identifier
1205611720
Registry record updated Aug 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.008875RX Issued in OH
Practice address
3188 Bellevue Ave
Cincinnati, OH 45219-2369
Phone
(513) 558-5281
NPI assigned
Aug 31, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50.008875RX OH Primary

Addresses

Primary practice location

3188 Bellevue Ave
Cincinnati, OH 45219-2369

Mailing address

3200 Burnet Ave
Cincinnati, OH 45229-3019

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
I20241028000738 OH Practitioner - Physician Assistant 8325495963 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
82 of 100Reported as group
Quality
65.97
Promoting interoperability
100
Improvement activities
40
Cost
74.01

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
50.008875RXOHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Cincinnati Physicians Company, LLC Physician Assistant CurrentSince Oct 1, 2024 Accepting new patients
University Surgical-Dental Associates, LLC Past Accepting new patients

Locations

2123 Auburn Ave
#A28
Cincinnati, OH 45219
Phone (513) 585-0523

3188 Bellevue Ave
Cincinnati, OH 45219
Phone (513) 558-5281

3200 Burnet Ave
#2
Cincinnati, OH 45229
Phone (513) 585-5505

3200 Burnet Ave
Cincinnati, OH 45229
Phone (513) 558-7700

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": "1693440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724803200000",
    "number": "1205611720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 BURNET AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452293019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3188 BELLEVUE AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452192369",
            "telephone_number": "513-558-5281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAHLBAUM",
        "first_name": "KYLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-31",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.008875RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

Verify at the official NPI Registry.