Individual provider Active NPI

Kathleen C Stiles, M.D.

  • Pediatrics Physician
  • Columbus, OH
National Provider Identifier
1386630739
Registry record updated Jun 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
35-082353 Issued in OH
Practice address
6503 E Broad St
Suite 100
Columbus, OH 43213-1692
Phone
(614) 434-5437
Fax
(614) 434-5438
NPI assigned
Sep 21, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 1, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 35-082353 OH Primary

Addresses

Primary practice location

6503 E Broad St
Suite 100
Columbus, OH 43213-1692

Mailing address

6503 E Broad St
Suite 100
Columbus, OH 43213-1692
Phone (614) 434-5437

Other identifiers 1

IdentifierTypeStateIssuer
2483174MedicaidOH

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040917000597 OH Practitioner - Pediatric Medicine 3678541653 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35-082353OHMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Ohio Primary Care Physicians, Inc. CurrentSince May 17, 2011 Accepting new patients
Central Ohio Primary Care Physicians, Inc. Pediatrics CurrentSince May 17, 2011 Accepting new patients
Central Ohio Primary Care Physicians Inc Current Accepting new patients

Locations

1080 Beecher Xing N
Ste B
Columbus, OH 43230

4885 Olentangy River Rd
Columbus, OH 43214
Phone (614) 326-5665

6503 E Broad St
Ste 100
Columbus, OH 43213
Phone (614) 434-5437

570 Polaris Pkwy
Ste 250
Westerville, OH 43082
Phone (614) 459-0216

Interoperability endpoints

  • Direct secure messaging: kstiles19140@copcp.medicity.net

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 and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306886400000",
    "number": "1386630739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6503 E BROAD ST",
            "address_2": "SUITE 100",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432131692",
            "telephone_number": "614-434-5437",
            "fax_number": "614-434-5438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6503 E BROAD ST",
            "address_2": "SUITE 100",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432131692",
            "telephone_number": "614-434-5437",
            "fax_number": "614-434-5438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STILES",
        "first_name": "KATHLEEN",
        "middle_name": "C",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-09-21",
        "last_updated": "2011-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35-082353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2483174",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.