Individual provider Active NPI

Jesse L Kuhlenschmidt, AGACNP-BC

  • Gerontology Nurse Practitioner
  • Evansville, IN
National Provider Identifier
1629640123
Registry record updated Sep 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
71012092 Issued in IN
Practice address
520 Mary St Ste 520
Evansville, IN 47710-1682
Phone
(812) 424-8231
Fax
(812) 435-8794
NPI assigned
Jul 14, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 71012092 IN Primary

Addresses

Primary practice location

520 Mary St Ste 520
Evansville, IN 47710-1682

Mailing address

520 Mary St Ste 520
Evansville, IN 47710-1682
Phone (812) 424-8231

Other identifiers 5

IdentifierTypeStateIssuer
7100795550MedicaidKY
71012092AOtherINSTATE LICENSE
300058540MedicaidIN
000001624090OtherBCBS
71012092BOtherINCONTROLLED SUBSTANCE LICENSE

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
I20220120001600 IN Practitioner - Nurse Practitioner 2961894159 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Therapy Associates, Inc.Group PAC ID 1951386275, 4 clinicians

Practice addresses (Care Compare)

4055 Gateway Blvd
Newburgh, IN 47630-8947
Phone (812) 858-2273

Hospital & facility affiliations

  • Deaconess Hospital Inc Hospital, Evansville, IN, CCN 150082
  • Deaconess Henderson Hospital Hospital, Henderson, KY, CCN 180056
  • Gibson General Hospital Hospital, Princeton, IN, CCN 151319

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
71012092INMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Therapy Associates Inc CurrentSince May 1, 2023 Accepting new patients

Locations

700 N Burkhardt Rd
Evansville, IN 47715
Phone (812) 474-1110

4055 Gateway Blvd
Newburgh, IN 47630
Phone (812) 842-2210

Organizations & group practices 1

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 4

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": "1626220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694044800000",
    "number": "1629640123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 MARY ST STE 520",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477101682",
            "telephone_number": "812-424-8231",
            "fax_number": "812-435-8794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 MARY ST STE 520",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477101682",
            "telephone_number": "812-424-8231",
            "fax_number": "812-435-8794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUHLENSCHMIDT",
        "first_name": "JESSE",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-14",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IN",
            "license": "71012092",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100795550",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "71012092A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300058540",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000001624090",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONTROLLED SUBSTANCE LICENSE",
            "identifier": "71012092B",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.