Active NPI
Jeffery D Lightfoot, PSYD
- Psychologist
- Indianapolis, IN
National Provider Identifier
1104865435
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 20041870
- Practice address
- 2601 Cold Spring Rd
Indianapolis, IN 46222-2202 - Phone
- (317) 274-8660
- NPI assigned
- Jun 5, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 20041870 | IN | Primary |
Addresses
Primary practice location
2601 Cold Spring Rd
Indianapolis, IN 46222-2202
Mailing address
550 N Meridian St
Ste 114
Indianapolis, IN 46204-1207
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200487810 | Medicaid | IN |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20041870 | IN | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Indiana University Psychiatric Associates, Inc. | Psychologist | Past | Accepting new patients |
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.
-
- Psychiatry Physician
- Indianapolis, IN
- NPI 1023063724
Psychologist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1266796800000",
"number": "1104865435",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "550 N MERIDIAN ST",
"address_2": "STE 114",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462041207"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2601 COLD SPRING RD",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462222202",
"telephone_number": "317-274-8660"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIGHTFOOT",
"first_name": "JEFFERY",
"middle_name": "D",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-05",
"last_updated": "2010-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "IN",
"license": "20041870",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200487810",
"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 Feb 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.