1. Home
  2. Directory
  3. Kentucky
  4. Edgewood
  5. Family Medicine
  6. NPI Profile

KARL M SCHMITT M.D.
NPI 1013953033
Family Medicine in Edgewood, KY

Active since June 20, 2006PECOS EnrolledAccepts Medicare Assignment
90.38/100
CMS Quality Rating
413 S LOOP RD, EDGEWOOD, KY 41017(859) 301-3800(859) 301-3987 Get Directions Write a Review

NPPES record last updated: March 22, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Nov 30, 2018, Sep 13, 2018, Sep 29, 2015 (3 updates tracked since 2015).

About Karl M Schmitt M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KARL M SCHMITT M.D. (NPI 1013953033) is an individual family medicine provider in Edgewood, Kentucky, licensed in Kentucky (28177) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS, is affiliated with St Elizabeth Ft Thomas, and is a graduate of University Of Cincinnati College Of Medicine (1990).

NPPES Registry Identity

NPI1013953033
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameKARL M SCHMITTCredential: M.D.
Location Address413 S LOOP RDEdgewood, KY 41017-5446
Mailing AddressPo Box 636324Cincinnati, OH 45263-6324 · (859) 301-3800 · Fax (859) 301-3987
Phone(859) 301-3800
Fax(859) 301-3987
Sole ProprietorNo
Medical School CMSUniversity Of Cincinnati College Of MedicineGraduated 1990
Enumeration DateJune 20, 2006
Last NPPES UpdateMarch 22, 20223 updates tracked since enumeration
NPPES CertifiedMarch 22, 2022
✔ NPI 1013953033 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in KY · 28177
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
413 S LOOP RD, Edgewood, KY 41017
Open in Google Maps ↗

Other Identifiers 4

Other080092518KY · Railroad Medicare
Other220017409KY · Railroad Medicare
Medicaid0101142OH
Medicaid64281777KY

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Home State Health, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Karl M Schmitt M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8224170014
PECOS Enrollment IDI20100115000769
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 9

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes 99233
Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.
87 services36 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
82 services61 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.
73 services18 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
65 services57 patients
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223
Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.
26 services26 patients
Hospital discharge day management, more than 30 minutes 99239
Hospital discharge day management over 30 minutes involves a detailed process to ensure a smooth transition from hospital to home. It includes final examinations, discussion of your hospital stay, post-discharge instructions, and coordinating follow-up care.
25 services24 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

St Elizabeth Ft Thomas

Acute Care Hospitals · Fort Thomas, KY
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number180001
Location85 North Grand AvenueFort Thomas, KY 41075 · Campbell County
Emergency services

St Elizabeth Edgewood

Acute Care Hospitals · Edgewood, KY
5/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number180035
Location1 Medical Village DriveEdgewood, KY 41017 · Kenton County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 41017 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$82.24 typical visit price
range $52.76 – $162.27
Typical copayment $20.56 (range $13.19 – $40.56)
Most-billed visit code 99203
Established Patient
$93.94 typical visit price
range $16.53 – $131.99
Typical copayment $23.48 (range $4.13 – $32.99)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

90.38/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality80.76
Promoting Interoperability100
Improvement Activities40

Reported Quality Measures

Pneumococcal Vaccination Status for Older Adults
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
87%93 patients4/55-star benchmark: 100%
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553
DME-Other DME · category DE017N
3 suppliers16 claims16 services$201.82 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

VICTORIA GRIFFITH WILLIAMS MD
Student in an Organized Health Care Education/Training Program
413 S LOOP RD
EDGEWOOD, KY 41017
Kenton County (859) 301-3800
JACLYN REPLOGLE LCSW
Social Worker
413 S LOOP RD
EDGEWOOD, KY 41017
Kenton County (859) 301-3800
MARGARET RAE WOODRUFF
Student in an Organized Health Care Education/Training Program
413 S LOOP RD
EDGEWOOD, KY 41017
Kenton County (859) 301-3800
LAUREN ASHLEY LAWRENCE DO
Student in an Organized Health Care Education/Training Program
413 S LOOP RD
EDGEWOOD, KY 41017
Kenton County (859) 301-3800
TREVOR JORDAN HOFFMAN MD
Student in an Organized Health Care Education/Training Program
413 S LOOP RD
EDGEWOOD, KY 41017
Kenton County (859) 301-3800
ANGELA WARNING MD
Student in an Organized Health Care Education/Training Program
413 S LOOP RD
EDGEWOOD, KY 41017
Kenton County (859) 301-3800
AMANDA GABRIELLE JEFFRIES DO
Family Medicine
413 S LOOP RD
EDGEWOOD, KY 41017
Kenton County (859) 301-3800
DR. NICOLE HOCKEMEYER MD
Student in an Organized Health Care Education/Training Program
413 S LOOP RD
EDGEWOOD, KY 41017
Kenton County (859) 301-3800

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Karl Schmitt's NPI number?

The NPI number for Karl Schmitt is 1013953033. It was assigned to this individual provider in the NPPES registry on June 20, 2006.

Where is Karl Schmitt located?

Karl Schmitt practices at 413 S Loop Rd, Edgewood, KY 41017. The listed phone number is (859) 301-3800.

What is Karl Schmitt's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Karl Schmitt enrolled in Medicare?

Yes. Karl Schmitt is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Karl Schmitt accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Home State Health, Ambetter of Tennessee and CareSource list Karl Schmitt as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Karl Schmitt affiliated with any hospitals?

According to CMS data, Karl Schmitt is affiliated with St Elizabeth Ft Thomas and St Elizabeth Edgewood.

When was this NPI record last updated?

The NPPES record for Karl Schmitt was last updated on March 22, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.