NPIMap

Individual provider Active NPI

Katelyn Michelle Rudolph, PA-C

  • Internal Medicine Physician
  • Geneva, OH
National Provider Identifier
1245059906
Registry record updated Oct 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
50.009087RX Issued in OH
Practice address
890 W Main St Ste 103
Geneva, OH 44041-1237
Phone
(440) 466-4641
NPI assigned
Oct 8, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 50.009087RX OH Primary

Addresses

Primary practice location

890 W Main St Ste 103
Geneva, OH 44041-1237

Mailing address

6230 Maxwell Dr
Madison, OH 44057-2011
Phone (910) 320-1406

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250122002786 OH Practitioner - Physician Assistant 5698204527 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lake Hospital System, Inc.Group PAC ID 6002713922, 92 clinicians

Practice addresses (Care Compare)

11100 Euclid Ave
Cleveland, OH 44106-1716

36500 Euclid Ave
Willoughby, OH 44094-4455
Phone (440) 516-0530

9500 Mentor Ave
Mentor, OH 44060-8714

Hospital & facility affiliations

  • University Hospital Home Care Services, Inc Home health agency, Warrensville HTS, OH, CCN 367424
  • Uh Regional Hospitals Hospital, Chardon, OH, CCN 360075
  • Uh Cleveland Medical Center Hospital, Cleveland, OH, CCN 360137
  • Lake Health Hospital, Concord, OH, CCN 360098

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50.009087RXOHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Hospital System, Inc Internal Medicine CurrentSince Mar 1, 2025 Accepting new patients
University Primary Care Practices Inc Internal Medicine CurrentSince Jan 13, 2025 Accepting new patients
University Primary Care Practices Inc CurrentSince Jan 13, 2025 Accepting new patients
Lake Hospital System CurrentSince Mar 1, 2025 Accepting new patients
Lake Hospital System, Inc Internal Medicine Past Accepting new patients

Locations

158 W Main Rd
Ste 203
Conneaut, OH 44030
Phone (440) 285-2960

890 W Main St
Ste 103
Geneva, OH 44041
Phone (440) 466-4641

9500 Mentor Ave
Ste 100
Mentor, OH 44060
Phone (440) 352-4880

Interoperability endpoints

  • Direct secure messaging: krudolph289517@ehrdirect.uhhospitals.org

Organizations & group practices 7

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 7

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": "1728345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728345600000",
    "number": "1245059906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6230 MAXWELL DR",
            "city": "MADISON",
            "state": "OH",
            "postal_code": "440572011",
            "telephone_number": "910-320-1406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "890 W MAIN ST STE 103",
            "city": "GENEVA",
            "state": "OH",
            "postal_code": "440411237",
            "telephone_number": "440-466-4641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "KATELYN",
        "middle_name": "MICHELLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-08",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "50.009087RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Geneva, OH

Sources for this page

Verify at the official NPI Registry.