Individual provider Active NPI

Kaitlin Coltharp, PA-C

  • Physician Assistant
  • Tuscola, IL
National Provider Identifier
1902528276
Registry record updated Nov 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085-009254 Issued in IL
Practice address
1100 Tuscola Blvd
Tuscola, IL 61953-2065
Phone
(217) 253-4764
Fax
(217) 253-4886
NPI assigned
Sep 14, 2022
Last updated
Nov 4, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2024

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 085-009254 IL Primary

Addresses

Primary practice location

1100 Tuscola Blvd
Tuscola, IL 61953-2065

Mailing address

PO Box 372
Mattoon, IL 61938-0372

Other practice location 1

2040 Lincoln Ave Ste 100
Charleston, IL 61920-3197
Phone (217) 345-2030

Other practice location 2

1303 W Evergreen Ave Ste 100
Effingham, IL 62401-1638
Phone (217) 540-6123

Other practice location 3

1201 Wooddell Way Ste B
Mattoon, IL 61938-1014
Phone (217) 238-3000

Other names 1

  • Kaitlin Stiner Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20221214000538 IL Practitioner - Physician Assistant 4587033568 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Southern Illinois University School of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sarah Bush Lincoln Health CenterGroup PAC ID 5092614867, 411 clinicians

Practice addresses (Care Compare)

1000 Health Ctr Dr
Mattoon, IL 61938-4644

101 Professional PLZ
Mattoon, IL 61938-9252
Phone (217) 238-3730

1100 Tuscola Blvd
Tuscola, IL 61953-2065
Phone (217) 253-2020

1201 Wooddell Way
Suite B
Mattoon, IL 61938-1014
Phone (217) 238-3000

1303 W Evergreen Ave
Effingham, IL 62401-1638

2040 Lincoln Ave
Charleston, IL 61920-3197

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.96 of 100Reported as apm
Quality
69.5
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
085-009254ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sarah Bush Lincoln Health Center CurrentSince Oct 12, 2022 Accepting new patients
Sarah Bush Lincoln Health Center CurrentSince Oct 12, 2022 Accepting new patients

Locations

2040 Lincoln Ave
Ste 100
Charleston, IL 61920
Phone (217) 345-2030

1303 W Evergreen Ave
Ste 100
Effingham, IL 62401
Phone (217) 540-6123

1000 Health Center Dr
Mattoon, IL 61938
Phone (217) 258-2389

1005 Health Center Dr
Ste 201
Mattoon, IL 61938
Phone (217) 238-6055

101 Professional Plz
Mattoon, IL 61938
Phone (217) 238-3730

1201 Wooddell Way
Ste B
Mattoon, IL 61938
Phone (217) 238-3000

1100 Tuscola Blvd
Tuscola, IL 61953
Phone (217) 253-2020

Organizations & group practices 2

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 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": "1663113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730678400000",
    "number": "1902528276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 372",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619380372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 TUSCOLA BLVD",
            "city": "TUSCOLA",
            "state": "IL",
            "postal_code": "619532065",
            "telephone_number": "217-253-4764",
            "fax_number": "217-253-4886"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2040 Lincoln Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "IL",
            "postal_code": "619203197",
            "country_code": "US",
            "telephone_number": "217-345-2030",
            "fax_number": "217-345-2045",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1303 W Evergreen Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Effingham",
            "state": "IL",
            "postal_code": "624011638",
            "country_code": "US",
            "telephone_number": "217-540-6123",
            "fax_number": "217-347-4969",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1201 Wooddell Way Ste B",
            "address_purpose": "LOCATION",
            "city": "Mattoon",
            "state": "IL",
            "postal_code": "619381014",
            "country_code": "US",
            "telephone_number": "217-238-3000",
            "fax_number": "217-238-3008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COLTHARP",
        "first_name": "KAITLIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-14",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-009254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAITLIN",
            "last_name": "STINER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tuscola, IL

Sources for this page

Verify at the official NPI Registry.