Active NPI
Jack Kessey
- Registered Dietitian
- Indianapolis, IN
National Provider Identifier
1093531600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 37003210A
- Practice address
- 9525 N Meridian St
Indianapolis, IN 46260-1310 - Phone
- (317) 210-3244
- NPI assigned
- Nov 27, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 37003210A | IN | Primary |
Addresses
Primary practice location
9525 N Meridian St
Indianapolis, IN 46260-1310
Mailing address
9525 N Meridian St
Indianapolis, IN 46260-1310
Phone (317) 210-3244
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 86104699 | Other | IN | COMMISSION ON DIETETIC COMMISSION |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37003210A | IN | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Impact Athletics Incorporated | Dietitian, Registered | Current | Accepting new patients |
Locations
9525 N Meridian St
Indianapolis, IN 46260
Phone (317) 210-3244
Organizations & group practices 1
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.
-
- Sports Medicine (Preventive Medicine) Physician
- Indianapolis, IN
- NPI 1568203610
Dietitian, Registered
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1732665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732665600000",
"number": "1093531600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9525 N MERIDIAN ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462601310",
"telephone_number": "317-210-3244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9525 N MERIDIAN ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462601310",
"telephone_number": "317-210-3244"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KESSEY",
"first_name": "JACK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-11-27",
"last_updated": "2024-11-27",
"certification_date": "2024-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IN",
"license": "37003210A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMISSION ON DIETETIC COMMISSION",
"identifier": "86104699",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.