Individual provider Active NPI

Kristen A Buerstatte, PA-C

  • Physician Assistant
  • Quincy, IL
National Provider Identifier
1841535309
Registry record updated Apr 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085009530 Issued in IL
Practice address
927 Broadway St
Quincy, IL 62301-2719
Phone
(217) 214-3424
Fax
(217) 221-1344
NPI assigned
Dec 10, 2012
Last updated
Apr 5, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 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 085009530 IL Primary
Physician Assistant 363A00000X 2023040348 MO

Addresses

Primary practice location

927 Broadway St
Quincy, IL 62301-2719

Mailing address

1005 Broadway St
Quincy, IL 62301-2834
Phone (217) 223-8400

Other practice location 1

100 Medical Dr
Hannibal, MO 63401-6877
Phone (217) 224-6423

Other names 1

  • Kristen A Vahle Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MO2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20230912000449 IL Practitioner - Physician Assistant 7810132644 Reassigns benefits to 1 organization
I20240413000279 MO Practitioner - Physician Assistant 7810132644 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Blessing HospitalGroup PAC ID 3072422534, 414 clinicians

Practice addresses (Care Compare)

100 Medical Dr
Hannibal, MO 63401-6877
Phone (573) 406-5800

1005 Broadway St
Quincy, IL 62301-2834
Phone (217) 223-8400

101 Medical Dr
Hannibal, MO 63401-6884
Phone (573) 221-5250

927 Broadway St
Quincy, IL 62301-2719
Phone (217) 224-6423

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2023040348MOMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Blessing Hospital CurrentSince Sep 18, 2023 Accepting new patients
West Central Pathology Specialists, S.C. Current Accepting new patients
Blessing Hospital CurrentSince Sep 18, 2023 Accepting new patients
Quincy Clinical Laboratory Services SC Current Accepting new patients
Blessing Hospital CurrentSince Jun 1, 2024 Accepting new patients
Medgen Urgent Care Maryland LLC Past Accepting new patients
Blessing Hospital Past Accepting new patients
Physical Medicine Associates LTD Past Accepting new patients

Locations

1005 Broadway St
Quincy, IL 62301

100 Medical Dr
Hannibal, MO 63401

101 Medical Dr
Hannibal, MO 63401

Interoperability endpoints

  • FHIR API: https://fhir.blessinghospital.com/R4/open-Prod

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

Hospital & facility affiliations 3

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": "1355097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712275200000",
    "number": "1841535309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 BROADWAY ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623012834",
            "telephone_number": "217-223-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "927 BROADWAY ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623012719",
            "telephone_number": "217-214-3424",
            "fax_number": "217-221-1344"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Medical Dr",
            "address_purpose": "LOCATION",
            "city": "Hannibal",
            "state": "MO",
            "postal_code": "634016877",
            "country_code": "US",
            "telephone_number": "217-224-6423",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUERSTATTE",
        "first_name": "KRISTEN",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-10",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085009530",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2023040348",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTEN",
            "last_name": "VAHLE",
            "middle_name": "A",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Quincy, IL

Sources for this page

Verify at the official NPI Registry.