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KELLY BULTMAN
NPI 1104491414
Physician Assistant in Beavercreek, OH

Active since May 20, 2021PECOS Enrolled
2510 COMMONS BLVD STE 210, BEAVERCREEK, OH 45431(513) 833-4912 Get Directions Write a Review

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

Record update history: Jul 22, 2022, May 20, 2021 (2 updates tracked since 2021).

About Kelly Bultman NPPES

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

KELLY BULTMAN (NPI 1104491414) is an individual physician assistant in Beavercreek, Ohio, licensed in Ohio (50.006573RX) and active in the NPI registry since May 2021. She is enrolled in Medicare PECOS and maintains a secondary practice location in Morrow.

NPPES Registry Identity

NPI1104491414
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameKELLY BULTMAN
Location Address2510 COMMONS BLVD STE 210Beavercreek, OH 45431-3821
Mailing Address2510 Commons Blvd Ste 210Beavercreek, OH 45431-3821 · (513) 833-4912
Phone(513) 833-4912
Sole ProprietorYes
Enumeration DateMay 20, 2021
Last NPPES UpdateJuly 22, 20222 updates tracked since enumeration
NPPES CertifiedJuly 22, 2022
✔ NPI 1104491414 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 · 50.006573RX
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.
2510 COMMONS BLVD STE 210, Beavercreek, OH 45431
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Secondary Practice Location 1

Location 14956 Jessica Suzanne DrMorrow, OH 45152-8056 · Phone (513) 833-4912

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include CareSource.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kelly Bultman is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 45431 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.

Other Providers at the Same Location NPPES 9

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

SARAH GOULD PA
Physician Assistant
2510 COMMONS BLVD STE 210
BEAVERCREEK, OH 45431
Greene County (937) 429-0607
MRS. TERESA D DITMER APRN-BC, CNS
Clinical Nurse Specialist (Adult Health)
2510 COMMONS BLVD STE 210
BEAVERCREEK, OH 45431
Greene County (937) 429-0607
ALEXANDRA WILSON PA-C
Physician Assistant
2510 COMMONS BLVD STE 210
BEAVERCREEK, OH 45431
Greene County (937) 429-0607
DR. LINDSEY NICOLE DAVIS D.O.
Internal Medicine
2510 COMMONS BLVD STE 210
BEAVERCREEK, OH 45431
Greene County (937) 429-0607
MAX M MIDKIFF
Nurse Practitioner (Acute Care)
2510 COMMONS BLVD STE 210
BEAVERCREEK, OH 45431
Greene County (937) 429-0607
KATHRYN GREEN PA
Physician Assistant (Medical)
2510 COMMONS BLVD STE 210
BEAVERCREEK, OH 45431
Greene County (937) 429-0607
REBECCA J HELFRICH M.D.
Internal Medicine
2510 COMMONS BLVD STE 210
BEAVERCREEK, OH 45431
Greene County (937) 558-3062
ANTHONY DURNING CNP
Nurse Practitioner (Acute Care)
2510 COMMONS BLVD STE 210
BEAVERCREEK, OH 45431
Greene County (937) 558-3062

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 Kelly Bultman's NPI number?

The NPI number for Kelly Bultman is 1104491414. It was assigned to this individual provider in the NPPES registry on May 20, 2021.

Where is Kelly Bultman located?

Kelly Bultman practices at 2510 Commons Blvd Ste 210, Beavercreek, OH 45431. The listed phone number is (513) 833-4912.

What is Kelly Bultman's specialty?

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

Is Kelly Bultman enrolled in Medicare?

Yes. Kelly Bultman is registered in the Medicare PECOS enrollment system.

What insurance does Kelly Bultman accept?

Health plans from CareSource list Kelly Bultman 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.

When was this NPI record last updated?

The NPPES record for Kelly Bultman was last updated on July 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.