Individual provider Active NPI

Katelyn Ellen Stechschulte, NP-C

  • Nurse Practitioner
  • Dayton, OH
National Provider Identifier
1508321431
Registry record updated Mar 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APRN.CNP.024011 Issued in OH
Practice address
1550 Yankee Park PL
Dayton, OH 45458-1868
Phone
(937) 439-4949
NPI assigned
Feb 5, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN.415162 OH
Nurse Practitioner 363L00000X APRN.CNP.024011 OH Primary

Addresses

Primary practice location

1550 Yankee Park PL
Dayton, OH 45458-1868

Mailing address

1550 Yankee Park PL
Dayton, OH 45458-1868
Phone (937) 439-4949

Other identifiers 1

IdentifierTypeStateIssuer
0341058MedicaidOH

Other names 1

  • Miss Katelyn Ellen Utendorf Former name

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
I20190412000854 OH Practitioner - Nurse Practitioner 2668713074 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pain Management Group LLCGroup PAC ID 0143453670, 54 clinicians

Practice addresses (Care Compare)

140 Fox Rd
Suite 103
Van Wert, OH 45891-2490
Phone (419) 232-6060

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75.6 of 100Reported as group
Quality
75.56
Improvement activities
40
Cost
59.98

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN.415162OHMDRegistered Nurse
APRN.CNP.024011OHMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pain Management Group LLC Nurse Practitioner CurrentSince Aug 19, 2024 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

442 W High St
Bryan, OH 43506
Phone (260) 266-8210

140 Fox Rd
Ste 103
Van Wert, OH 45891
Phone (419) 228-7275

140 Fox Rd
Ste 102
Van Wert, OH 45891
Phone (419) 232-6060

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 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": "1549324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585440000000",
    "number": "1508321431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 YANKEE PARK PL",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454581868",
            "telephone_number": "937-439-4949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 YANKEE PARK PL",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454581868",
            "telephone_number": "937-439-4949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STECHSCHULTE",
        "first_name": "KATELYN",
        "middle_name": "ELLEN",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-05",
        "last_updated": "2020-03-29",
        "certification_date": "2020-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN.415162",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "APRN.CNP.024011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0341058",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATELYN",
            "last_name": "UTENDORF",
            "middle_name": "ELLEN",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.