Individual provider Active NPI

William Selby, DO

  • Pediatrics Physician
  • Evansville, IN
National Provider Identifier
1083651129
Registry record updated Aug 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
02003164A Issued in IN
Practice address
7220 E Virginia St
Evansville, IN 47715-4068
Phone
(812) 473-8986
NPI assigned
May 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 20A8925 CA
Pediatrics Physician 208000000X 02003164A IN Primary

Addresses

Primary practice location

7220 E Virginia St
Evansville, IN 47715-4068

Mailing address

7220 E Virginia St
Evansville, IN 47715-4068

Other identifiers 1

IdentifierTypeStateIssuer
200857430MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address william.selby.1@7598.direct.athenahealth.com St Mary's Medical Group, LLC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070523000014 IN Practitioner - Pediatric MedicinePractitioner - Osteopathic Manipulative Medicine 0648282483 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Osteopathic Manipulative Medicine
Education
New York College of Osteo Medicine of New York Institute of Technology, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Marys Medical Group LLCGroup PAC ID 1153493341, 230 clinicians

Practice addresses (Care Compare)

7220 E Virginia St
Evansville, IN 47715-4068
Phone (812) 473-8986

801 Saint Marys Dr
505E
Evansville, IN 47714-0528
Phone (812) 491-3236

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
20A8925CAMDPediatrics Physician
02003164AINMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Mary'S Medical Group, LLC Pediatrics CurrentSince Jun 1, 2014 Accepting new patients
St Mary'S Medical Group, LLC CurrentSince Jun 1, 2014 Accepting new patients
St. Mary'S Health, Inc Pediatrics Past Accepting new patients

Locations

801 Saint Marys Dr
Ste 505E
Evansville, IN 47714
Phone (812) 491-3236

7220 E Virginia St
Evansville, IN 47715
Phone (812) 473-8986

250 W 96th St
#520
Indianapolis, IN 46260
Phone (317) 583-3331

100 St Marys Epworth Xing
Ste A100
Newburgh, IN 47630
Phone (812) 469-8160

Interoperability endpoints

  • Direct secure messaging: william.selby.1@7598.direct.athenahealth.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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660608000000",
    "number": "1083651129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7220 E VIRGINIA ST",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477154068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7220 E VIRGINIA ST",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477154068",
            "telephone_number": "812-473-8986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELBY",
        "first_name": "WILLIAM",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "20A8925",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "02003164A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200857430",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "william.selby.1@7598.direct.athenahealth.com",
            "affiliation": "Y",
            "affiliationName": "St Mary's Medical Group, LLC",
            "address_1": "7220 E Virginia St",
            "city": "Evansville",
            "state": "IN",
            "country_code": "US",
            "postal_code": "477154068",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.