Individual provider Active NPI

Shelby Jean Thornton, A.P.R.N.

  • Nurse Practitioner
  • Fort Mitchell, KY
National Provider Identifier
1053577189
Registry record updated Sep 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
3005772 Issued in KY
Practice address
2300 Chamber Center Drive
Suite 100
Fort Mitchell, KY 41017-1673
Phone
(859) 341-3114
Fax
(859) 578-2156
NPI assigned
Jul 29, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 3005772 KY Primary

Addresses

Primary practice location

2300 Chamber Center Drive
Suite 100
Fort Mitchell, KY 41017-1673

Mailing address

PO Box 635283
Cincinnati, OH 45263-5283
Phone (859) 341-3114

Other identifiers 4

IdentifierTypeStateIssuer
P00821192OtherKYRAILROAD MEDICARE
3085138MedicaidOH
7100077370MedicaidKY
P00726170OtherKYRAILROAD MEDICARE

Other names 1

  • Shelby Jean Hurst Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20090317000150 KY Practitioner - Nurse Practitioner 4082771183 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Medical Group IncGroup PAC ID 2163326240, 803 clinicians

Practice addresses (Care Compare)

2300 Chamber Ctr Dr
Suite 100
Lakeside Park, KY 41017-1686
Phone (859) 341-3114

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3005772KYMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group, Inc. CurrentSince Jan 1, 2010 Accepting new patients
Summit Medical Group, Inc Nurse Practitioner CurrentSince Jan 1, 2010 Accepting new patients
Cincinnati Health Care Group PSC Past Accepting new patients

Locations

79 Country Club Dr
Butler, KY 41006
Phone (859) 344-5481

340 Thomas More Pkwy
#160
Crestview Hills, KY 41017

334 Thomas More Pkwy
Crestview Hills, KY 41017
Phone (859) 331-6065

1980 Litton Ln
Hebron, KY 41048
Phone (859) 334-8700

2300 Chamber Center Dr
Ste 100
Lakeside Park, KY 41017
Phone (859) 331-2440

300 Barnes Rd
Williamstown, KY 41097
Phone (859) 824-8217

Interoperability endpoints

  • Direct secure messaging: sthornton4963@direct-prd.stelizabeth.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1217289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536624000000",
    "number": "1053577189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 635283",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452635283",
            "telephone_number": "859-341-3114",
            "fax_number": "859-578-2156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 CHAMBER CENTER DRIVE",
            "address_2": "SUITE 100",
            "city": "FORT MITCHELL",
            "state": "KY",
            "postal_code": "410171673",
            "telephone_number": "859-341-3114",
            "fax_number": "859-578-2156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THORNTON",
        "first_name": "SHELBY",
        "middle_name": "JEAN",
        "credential": "A.P.R.N.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-29",
        "last_updated": "2018-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "3005772",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00821192",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3085138",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100077370",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00726170",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELBY",
            "last_name": "HURST",
            "middle_name": "JEAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fort Mitchell, KY

Sources for this page

Verify at the official NPI Registry.