Individual provider Active NPI

Tina Marie Gutekunst

  • Nurse Practitioner
  • Ft Mitchell, KY
National Provider Identifier
1295184679
Registry record updated Jan 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
3010634 Issued in KY
Practice address
2300 Chamber Center Drive
Ft. Mitchell, KY 41017
Phone
(859) 341-3114
Fax
(859) 578-2156
NPI assigned
Jun 7, 2016
Last updated
Jan 11, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 71009290A IN
Nurse Practitioner 363L00000X 3010634 KY Primary
Family Nurse Practitioner 363LF0000X COA.18966-NP OH

Addresses

Primary practice location

2300 Chamber Center Drive
Ft. Mitchell, KY 41017

Mailing address

PO Box 635283
Cincinnati, OH 45263-5283
Phone (859) 341-3114

Other names 1

  • Tina Marie Bailey Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, KY2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160823003056 OH Practitioner - Nurse Practitioner 6608161146 Reassigns benefits to 1 organization
I20161021002126 KY Practitioner - Nurse Practitioner 6608161146 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Cincinnati College of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Summit Medical Group IncGroup PAC ID 2163326240, 803 clinicians

Practice addresses (Care Compare)

2300 Chamber Ctr Dr
Suite 100
Lakeside Park, KY 41017-1686
Phone (859) 341-3114

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
71009290AINMDNurse Practitioner
3010634KYMDNurse Practitioner
COA.18966-NPOHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group, Inc. CurrentSince Nov 25, 2019 Accepting new patients
Pain Specialists of Cincinnati, LLC CurrentSince Apr 25, 2018 Accepting new patients
Summit Medical Group, Inc Nurse Practitioner CurrentSince Nov 25, 2019 Accepting new patients

Locations

230 6th St
Rising Sun, IN 47040
Phone (812) 438-2555

1980 Litton Ln
Hebron, KY 41048
Phone (859) 334-8700

2300 Chamber Center Dr
Ste 100
Lakeside Park, KY 41017
Phone (859) 331-2440

300 Barnes Rd
Williamstown, KY 41097
Phone (859) 824-8217

3328 Westbourne Dr
Cincinnati, OH 45248
Phone (513) 922-1599

Interoperability endpoints

  • Direct secure messaging: tgutekunst297349@direct-prd.stelizabeth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 4

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": "1465257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673395200000",
    "number": "1295184679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 635283",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452635283",
            "telephone_number": "859-341-3114",
            "fax_number": "859-578-2156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 CHAMBER CENTER DRIVE",
            "city": "FT. MITCHELL",
            "state": "KY",
            "postal_code": "41017",
            "telephone_number": "859-341-3114",
            "fax_number": "859-578-2156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUTEKUNST",
        "first_name": "TINA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-07",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71009290A",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "3010634",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "COA.18966-NP",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TINA",
            "last_name": "BAILEY",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Ft Mitchell, KY

Sources for this page

Verify at the official NPI Registry.