Individual provider Active NPI

Kelli Kristina Huesman, PA

  • Physician Assistant
  • Dayton, OH
National Provider Identifier
1700817483
Registry record updated Dec 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50001917 Issued in OH
Practice address
1 Wyoming St
Suite 3272
Dayton, OH 45409-2722
Phone
(937) 208-6790
Fax
(937) 208-6797
NPI assigned
Jul 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2013

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 50001917 OH Primary

Addresses

Primary practice location

1 Wyoming St
Suite 3272
Dayton, OH 45409-2722

Mailing address

1 Wyoming St
Suite 3272
Dayton, OH 45409-2722
Phone (937) 208-6790

Other identifiers 1

IdentifierTypeStateIssuer
0067486MedicaidOH

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
I20041213000069 OH Practitioner - Physician Assistant 0042277006 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Premier Health Specialists IncGroup PAC ID 5597708594, 576 clinicians

Practice addresses (Care Compare)

1 Wyoming St
Dayton, OH 45409-2722

1 Wyoming St
Berry Women'S Center Labor and Delivery
Dayton, OH 45409-2939
Phone (937) 439-4381

30 E Apple St
Dayton, OH 45409-2939

450 N Hyatt St
Suite 304
Tipp City, OH 45371-1433
Phone (937) 832-4773

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.38 of 100Reported as group
Quality
66.25
Promoting interoperability
100
Improvement activities
40
Cost
71.69

Merit-based Incentive Payment System (MIPS)

Final score
84.17 of 100Reported as group
Quality
65.6
Promoting interoperability
100
Improvement activities
40
Cost
74.7

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50001917OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mvhe, Inc Physician Assistant CurrentSince Jan 8, 2010 Accepting new patients
Premier Health Specialists Inc CurrentSince Aug 26, 2011 Accepting new patients
Premier Health Specialists Inc CurrentSince Aug 26, 2011 Accepting new patients
Mvhe Inc CurrentSince Jan 8, 2010 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Premier Heart Associates, Inc Past Accepting new patients

Locations

2451 Wayne Ave
Dayton, OH 45420
Phone (937) 252-1831

30 E Apple St
#6258
Dayton, OH 45409
Phone (937) 208-5300

30 E Apple St
Ste 6221
Dayton, OH 45409
Phone (937) 208-6630

1 Wyoming St
Ste 3272
Dayton, OH 45409
Phone (937) 208-2126

3170 Kettering Blvd
Bldg B
Moraine, OH 45439
Phone (937) 991-3187

450 N Hyatt St
Ste 304
Tipp City, OH 45371
Phone (937) 832-4773

Interoperability endpoints

  • Direct secure messaging: kelli.huesman.1@29318.direct.athenahealth.com

Organizations & group practices 8

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": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1388016000000",
    "number": "1700817483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 WYOMING ST",
            "address_2": "SUITE 3272",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454092722",
            "telephone_number": "937-208-6790",
            "fax_number": "937-208-6797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WYOMING ST",
            "address_2": "SUITE 3272",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454092722",
            "telephone_number": "937-208-6790",
            "fax_number": "937-208-6797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUESMAN",
        "first_name": "KELLI",
        "middle_name": "KRISTINA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-05",
        "last_updated": "2013-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50001917",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0067486",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.