Individual provider Active NPI

Madison Kaye Oakes-Dutkevitch

  • Physician Assistant
  • Cincinnati, OH
National Provider Identifier
1396488748
Registry record updated Dec 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.007821RX Issued in OH
Practice address
8459 Colerain Ave
Cincinnati, OH 45239-3938
Phone
(434) 944-0053
NPI assigned
Apr 14, 2022
Last updated
Dec 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50.007821RX OH Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

8459 Colerain Ave
Cincinnati, OH 45239-3938

Mailing address

1430 Oak CT Ste 100
Beavercreek, OH 45430-1064
Phone (937) 404-1101

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
I20221017000937 OH Practitioner - Physician Assistant 4880060946 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50.007821RXOHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Hometown Urgent Care of Michigan, P.C. CurrentSince Oct 24, 2022 Accepting new patients
Urgent Care Specialists, LLC PastSince May 13, 2015 Accepting new patients

Locations

6210 Brandt Pike
Huber Heights, OH 45424
Phone (937) 236-8630

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1649894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733875200000",
    "number": "1396488748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 OAK CT STE 100",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454301064",
            "telephone_number": "937-404-1101",
            "fax_number": "937-404-1210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8459 COLERAIN AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452393938",
            "telephone_number": "434-944-0053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OAKES-DUTKEVITCH",
        "first_name": "MADISON",
        "middle_name": "KAYE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-14",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.007821RX",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

Verify at the official NPI Registry.