Individual provider Active NPI

Nicole Amber Kestufskie, PA

  • Physician Assistant
  • Avon, IN
National Provider Identifier
1316424344
Registry record updated Mar 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
8244 E US Highway 36 Ste 1100
Avon, IN 46123
Phone
(317) 272-7500
Fax
(317) 272-7515
NPI assigned
Jul 23, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2021

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 Primary

Addresses

Primary practice location

8244 E US Highway 36 Ste 1100
Avon, IN 46123

Mailing address

8244 E US Highway 36 Ste 1100
Avon, IN 46123-9627
Phone (317) 272-7500

Other names 1

  • Nicole Amber Zimmerman Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address nzimmerman233419@direct-PRD.stelizabeth.com

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
I20180809000616 IN Practitioner - Physician Assistant 7618225590 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hendricks County HospitalGroup PAC ID 4880505528, 341 clinicians

Practice addresses (Care Compare)

1100 Southfield Dr
Plainfield, IN 46168-4499

5492 N Ronald Reagan Pkwy
Suite 130
Brownsburg, IN 46112-5618
Phone (317) 456-9050

8244 E US Hwy 36 1100
Hendricks Community Hospital
Avon, IN 46123-9627
Phone (317) 272-7500

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Hendricks County Hospital CurrentSince Aug 13, 2018 Accepting new patients
Hendricks County Hospital CurrentSince Aug 13, 2018 Accepting new patients
Hendricks County Hospital Past Accepting new patients
Hendricks County Hospital Past Accepting new patients
Hendricks County Hospital Past Accepting new patients

Locations

8244 E US Highway 36
Ste 1100
Avon, IN 46123
Phone (317) 272-7500

5492 N Ronald Reagan Pkwy
Ste 130
Brownsburg, IN 46112
Phone (317) 456-9050

1100 Southfield Dr
Ste 1140
Plainfield, IN 46168
Phone (317) 839-7200

1100 Southfield Dr
Ste 1370
Plainfield, IN 46168
Phone (317) 837-5570

Interoperability endpoints

  • FHIR API: https://sehproxy.stelizabeth.com/arr-fhir/api/FHIR/R4

Organizations & group practices 6

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": "1532304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616025600000",
    "number": "1316424344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8244 E US HIGHWAY 36 STE 1100",
            "city": "AVON",
            "state": "IN",
            "postal_code": "461239627",
            "telephone_number": "317-272-7500",
            "fax_number": "317-272-7515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8244 E US HIGHWAY 36 STE 1100",
            "city": "AVON",
            "state": "IN",
            "postal_code": "46123",
            "telephone_number": "317-272-7500",
            "fax_number": "317-272-7515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KESTUFSKIE",
        "first_name": "NICOLE",
        "middle_name": "AMBER",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-23",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nzimmerman233419@direct-PRD.stelizabeth.com",
            "affiliation": "N",
            "address_1": "8244 E US Highway 36 Ste 1100",
            "city": "Avon",
            "state": "IN",
            "country_code": "US",
            "postal_code": "46123",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "ZIMMERMAN",
            "middle_name": "AMBER",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Avon, IN

Sources for this page

Verify at the official NPI Registry.