Individual provider Active NPI

Nathan John Mittlesteadt, PA-C

  • Physician Assistant
  • Louisville, KY
National Provider Identifier
1578865283
Registry record updated Nov 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
TC058 Issued in KY
Practice address
3 Audubon Plaza Dr
Louisville, KY 40217-1300
Phone
(502) 634-6767
NPI assigned
Dec 1, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2022

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 TC058 KY Primary

Addresses

Primary practice location

3 Audubon Plaza Dr
Louisville, KY 40217-1300

Mailing address

10706 Impatiens St
Prospect, KY 40059-7542
Phone (850) 450-8750

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20121101000189 KY Practitioner - Physician Assistant 0749430585 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baptist Health Medical Group IncGroup PAC ID 5597867184, 2,431 clinicians

Practice addresses (Care Compare)

1025 New Moody LN
La Grange, KY 40031-9154
Phone (502) 222-3255

3900 Kresge Way
Louisville, KY 40207-4681

4002 Kresge Way
Suite 110
Louisville, KY 40207-4605
Phone (502) 928-8700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.29 of 100Reported as apm
Quality
87.32
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
81.11 of 100Reported as group
Quality
63.34
Promoting interoperability
100
Improvement activities
40
Cost
73.68

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
TC058KYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Health Medical Group Inc CurrentSince Sep 6, 2023 Accepting new patients
Baptist Medical Associates Inc CurrentSince Sep 6, 2023 Accepting new patients
Community Medical Associates, Inc. CurrentSince Sep 4, 2023 Accepting new patients
Community Medical Associates, Inc. CurrentSince Sep 4, 2023 Accepting new patients
Baptist Health Medical Group Inc Physician Assistant Past Accepting new patients
Marshall Emergency Services Associates, PLLC Physician Assistant Past Accepting new patients

Locations

60 Mercy Ct
Irvine, KY 40336
Phone (606) 723-2115

2400 Eastpoint Pkwy
Ste 580
Louisville, KY 40223
Phone (502) 893-7710

3900 Kresge Way
Ste 41
Louisville, KY 40207
Phone (502) 896-1313

825 Barret Ave
Louisville, KY 40204
Phone (502) 272-5165

5200 Commerce Crossings Dr
Fl 3
Louisville, KY 40229
Phone (502) 253-4924

1 Audubon Plaza Dr
Louisville, KY 40217
Phone (502) 634-6767

Organizations & group practices 7

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 2

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": "1291161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668384000000",
    "number": "1578865283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10706 IMPATIENS ST",
            "city": "PROSPECT",
            "state": "KY",
            "postal_code": "400597542",
            "telephone_number": "850-450-8750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 AUDUBON PLAZA DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402171300",
            "telephone_number": "502-634-6767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITTLESTEADT",
        "first_name": "NATHAN",
        "middle_name": "JOHN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-12-01",
        "last_updated": "2022-11-14",
        "certification_date": "2022-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "TC058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.