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KIRSTEN M UPTON PA-C
NPI 1083156459
Physician Assistant in Centerville, OH

Active since November 16, 2016PECOS EnrolledAccepts Medicare Assignment
87.82/100
CMS Quality Rating
1975 MIAMISBURG CENTERVILLE RD, CENTERVILLE, OH 45459(937) 439-6186(937) 723-2638 Get Directions Write a Review

NPPES record last updated: October 30, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Aug 7, 2024, Jul 21, 2022, Mar 17, 2018 and 2 more (5 updates tracked since 2016).

About Kirsten M Upton Pa-c NPPES

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

KIRSTEN M UPTON PA-C (NPI 1083156459) is an individual physician assistant in Centerville, Ohio, licensed in Ohio (50.004881RX) and active in the NPI registry since November 2016. She is enrolled in Medicare PECOS, is affiliated with Kettering Health Greene Memorial, and maintains a secondary practice location in Kettering.

NPPES Registry Identity

NPI1083156459
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameKIRSTEN M UPTONCredential: PA-C
Location Address1975 MIAMISBURG CENTERVILLE RDCenterville, OH 45459-3811
Mailing Address1975 Miamisburg Centerville RdCenterville, OH 45459-3811 · (937) 439-6186 · Fax (937) 723-2638
Phone(937) 439-6186
Fax(937) 723-2638
Sole ProprietorYes
Medical School CMSOtherGraduated 2016
Enumeration DateNovember 16, 2016
Last NPPES UpdateOctober 30, 20245 updates tracked since enumeration
NPPES CertifiedOctober 30, 2024
✔ NPI 1083156459 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in OH · 50.004881RX
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
1975 MIAMISBURG CENTERVILLE RD, Centerville, OH 45459
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Secondary Practice Location 1

Location 13533 Southern Blvd Ste 5200Kettering, OH 45429-1275 · Phone (937) 395-8002 · Fax (937) 395-8139

Other Identifiers 1

Other50.004881RXOH · License

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include CareSource, MedMutual, Molina Healthcare 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

Kirsten M Upton Pa-c 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 ID9133401177
PECOS Enrollment IDI20170126001607
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 6

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.

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.
285 services203 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.
260 services218 patients
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215
This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
59 services51 patients
Electronic analysis of implanted brain, spinal cord, or peripheral neurostimulator generator with brain stimulator programming, first 15 minutes with qualified health professional 95983
This procedure involves a medical professional using electronic equipment to analyze and adjust your implanted neurostimulator, which helps manage nerve activity in your brain, spinal cord, or peripheral nerves. The process typically takes 15 minutes.
47 services31 patients
Electronic analysis of implanted brain, spinal cord, or peripheral neurostimulator generator with brain stimulator programming, each additional 15 minutes with qualified health professional 95984
This procedure involves the evaluation of implanted neurostimulators in the brain, spinal cord, or peripheral nerves. It includes programming adjustments to optimize its function. A qualified health professional performs this every additional 15 minutes to ensure proper functioning.
47 services31 patients
Evaluation of neuropsychological test, first hour 96132
An evaluation of neuropsychological tests is a process to assess your brain's function. It involves tasks designed to measure cognitive abilities such as memory, attention, problem-solving, and language skills. The first hour involves initial testing and observation.
29 services28 patients

Hospital Affiliations CMS Care Compare 4

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

Kettering Health Greene Memorial

Acute Care Hospitals · Xenia, OH
OwnershipVoluntary non-profit - Private
CMS Certification Number360026
Location1141 North Monroe DriveXenia, OH 45385 · Greene County
Emergency services

Kettering Health Main Campus

Acute Care Hospitals · Kettering, OH
4/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number360079
Location3535 Southern BoulevardKettering, OH 45429 · Montgomery County
Emergency services Birthing friendly

Kettering Health Dayton

Acute Care Hospitals · Dayton, OH
3/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number360133
Location405 Grand AvenueDayton, OH 45405 · Montgomery County
Birthing friendly

Kettering Health Miamisburg

Acute Care Hospitals · Miamisburg, OH
3/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number360239
Location4000 Miamisburg-Centerville RoadMiamisburg, OH 45342 · Montgomery County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 45459 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
$84.72 typical visit price
range $54.34 – $166.65
Typical copayment $21.18 (range $13.58 – $41.66)
Most-billed visit code 99203
Established Patient
$68.07 typical visit price
range $17.10 – $135.40
Typical copayment $17.01 (range $4.27 – $33.85)
Most-billed visit code 99213
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.

87.82/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Individually scored
Quality78.58
Promoting Interoperability99
Improvement Activities40
Cost81.67

Reported Quality Measures

Advance Care Plan
94%766 patients4/55-star benchmark: 100%
Closing the Referral Loop: Receipt of Specialist Report
41%302 patients2/55-star benchmark: 87%
Colorectal Cancer Screening
17%817 patients1/55-star benchmark: 88%
Controlling High Blood Pressure
88%182 patients4/55-star benchmark: 91%
Dementia: Cognitive Assessment
47%55 patients
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)
Lower rates are better for this measure.
96%98 patients1/55-star benchmark: 91%
Documentation of Current Medications in the Medical Record
100%2,394 patients5/55-star benchmark: 100%
e-Prescribing
99%1,021 patients4/55-star benchmark: 100%
Falls: Screening for Future Fall Risk
74%745 patients3/55-star benchmark: 100%
HIV Screening
0%809 patients1/55-star benchmark: 60%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
27%1,491 patients2/55-star benchmark: 98%
Preventive Care and Screening: Screening for Depression and Follow-Up Plan
25%1,227 patients2/55-star benchmark: 97%
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented
32%1,973 patients3/55-star benchmark: 61%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Patients combinedPopulations: 94% · 962 patients
Patients screened: 100% · 962 patients
28%81 patients2/55-star benchmark: 100%
Provide Patients Electronic Access to Their Health Information
78%644 patients4/55-star benchmark: 100%
Statin Therapy for the Prevention and Treatment of Cardiovascular Disease
67%284 patients3/55-star benchmark: 91%
Use of High-Risk Medications in Older Adults
Lower rates are better for this measure.
Patients appropriateDiagnosis: 2% · 767 patients
Patients totalRate: 6% · 775 patients
5%775 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 12

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

Tubing with integrated heating element for use with positive airway pressure device A4604
DME-Other DME · category DE001N
8 suppliers67 claims67 services$31.51 avg. paid by Medicare
Full face mask used with positive airway pressure device, each A7030
DME-Other DME · category DE001N
7 suppliers39 claims39 services$76.97 avg. paid by Medicare
Face mask interface, replacement for full face mask, each A7031
DME-Other DME · category DE001N
6 suppliers35 claims93 services$29.74 avg. paid by Medicare
Cushion for use on nasal mask interface, replacement only, each A7032
DME-Other DME · category DE001N
6 suppliers25 claims141 services$15.71 avg. paid by Medicare
Pillow for use on nasal cannula type interface, replacement only, pair A7033
DME-Other DME · category DE001N
3 suppliers26 claims153 services$10.76 avg. paid by Medicare
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap A7034
DME-Other DME · category DE001N
6 suppliers55 claims55 services$40.39 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.

DR. TIMOTHY LEE SCHOONOVER D.O.
Psychiatry & Neurology (Neurology)
1975 MIAMISBURG CENTERVILLE RD
CENTERVILLE, OH 45459
Montgomery County (937) 439-6186
RACHEL HURTUBISE PA-C
Physician Assistant
1975 MIAMISBURG CENTERVILLE RD
WASHINGTON TOWNSHIP, OH 45459
Montgomery County (937) 439-6186
CAMILLE ELIZABETH HUGHES PA-C
Physician Assistant (Medical)
1975 MIAMISBURG CENTERVILLE RD
CENTERVILLE, OH 45459
Montgomery County (937) 439-6186
MARTHA ELIZABETH BAUMANN
Nurse Practitioner
1975 MIAMISBURG CENTERVILLE RD
CENTERVILLE, OH 45459
Montgomery County (937) 439-6186
MEGAN MILLER FNP-C
Nurse Practitioner (Family)
1975 MIAMISBURG CENTERVILLE RD
CENTERVILLE, OH 45459
Montgomery County (937) 439-6186
ANGELA SUE WRIGHT NP
Nurse Practitioner (Family)
1975 MIAMISBURG CENTERVILLE RD
CENTERVILLE, OH 45459
Montgomery County (937) 439-6186
MS. KRISTI R KAEFF PA
Physician Assistant (Medical)
1975 MIAMISBURG CENTERVILLE RD
CENTERVILLE, OH 45459
Montgomery County (937) 439-6186
EMILY DOWD FNP
Nurse Practitioner (Family)
1975 MIAMISBURG CENTERVILLE RD
CENTERVILLE, OH 45459
Montgomery County (937) 439-6186

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 Kirsten Upton's NPI number?

The NPI number for Kirsten Upton is 1083156459. It was assigned to this individual provider in the NPPES registry on November 16, 2016.

Where is Kirsten Upton located?

Kirsten Upton practices at 1975 Miamisburg Centerville Rd, Centerville, OH 45459. The listed phone number is (937) 439-6186.

What is Kirsten Upton's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Kirsten Upton enrolled in Medicare?

Yes. Kirsten Upton 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 Kirsten Upton accept?

Health plans from CareSource, MedMutual, Molina Healthcare, Oscar Health Insurance and UnitedHealthcare list Kirsten Upton 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 Kirsten Upton affiliated with any hospitals?

According to CMS data, Kirsten Upton is affiliated with Kettering Health Greene Memorial, Kettering Health Main Campus, Kettering Health Dayton and Kettering Health Miamisburg.

When was this NPI record last updated?

The NPPES record for Kirsten Upton was last updated on October 30, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months 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.