NPIMap

Individual provider Active NPI

Katelyn S Ponsoll, PA-C

  • Medical Physician Assistant
  • Erie, PA
National Provider Identifier
1841777190
Registry record updated Nov 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
OA007090 Issued in PA
Practice address
5535 Peach St FL 1
Erie, PA 16509-2603
Phone
(814) 868-3488
Fax
(814) 868-3499
NPI assigned
Jul 19, 2018
Last updated
Nov 26, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X MA059802 PA
Medical Physician Assistant 363AM0700X OA007090 PA Primary

Addresses

Primary practice location

5535 Peach St FL 1
Erie, PA 16509-2603

Mailing address

1 Lecom PL
Erie, PA 16505-2571
Phone (814) 868-2529

Other names 1

  • Katelyn S Reisenauer Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180904002798 PA Practitioner - Physician Assistant 2769732270 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Millcreek Community HospitalGroup PAC ID 8426020173, 67 clinicians

Practice addresses (Care Compare)

5535 Peach St
FL 1
Erie, PA 16509-2603
Phone (814) 868-3488

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA059802PAMDMedical Physician Assistant
OA007090PAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Millcreek Community Hospital Current Accepting new patients
Corry Memorial Hospital Association CurrentSince Jan 1, 2025 Accepting new patients
Medical Associates of Erie CurrentSince Jan 1, 2025 Accepting new patients
Corry Memorial Hospital Association CurrentSince Jan 1, 2025 Accepting new patients
Millcreek Community Hospital CurrentSince Jan 1, 2025 Accepting new patients
Millcreek Community Hospital Endocrinology, Diabetes & Metabolism CurrentSince Jan 1, 2025 Accepting new patients

Locations

965 Shamrock Ln
Corry, PA 16407
Phone (814) 644-4641

1 Lecom Pl
Erie, PA 16505

240 W 11th St
Ste 2
Erie, PA 16501
Phone (814) 452-2218

2625 Parade St
Erie, PA 16504
Phone (814) 452-6383

5515 Peach St
Erie, PA 16509
Phone (814) 864-4031

5535 Peach St
#1
Erie, PA 16509

5535 Peach St
Fl 1
Erie, PA 16509
Phone (814) 868-3488

101 E High St
Union City, PA 16438
Phone (814) 438-2088

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/10044/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir-usa.unify.chbase.com/org/corrymh-73713d5f
  • Direct secure messaging: katelyn.ponsoll.1@10044.direct.athenahealth.com

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 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1531958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732579200000",
    "number": "1841777190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 LECOM PL",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165052571",
            "telephone_number": "814-868-2529",
            "fax_number": "814-868-2522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5535 PEACH ST FL 1",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165092603",
            "telephone_number": "814-868-3488",
            "fax_number": "814-868-3499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONSOLL",
        "first_name": "KATELYN",
        "middle_name": "S",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-19",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA059802",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "OA007090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATELYN",
            "last_name": "REISENAUER",
            "middle_name": "S",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Erie, PA

Sources for this page

Verify at the official NPI Registry.