Individual provider Active NPI

Tori Shaak-Johnston, APRN

  • Nurse Practitioner
  • Louisville, KY
National Provider Identifier
1174307623
Registry record updated Sep 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4022441 Issued in KY
Practice address
4003 Kresge Way Ste 400
Louisville, KY 40207-4652
Phone
(502) 895-7265
NPI assigned
Aug 23, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2024

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 4022441 KY Primary

Addresses

Primary practice location

4003 Kresge Way Ste 400
Louisville, KY 40207-4652

Mailing address

1901 Campus PL
Louisville, KY 40299-2308

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
I20241023004430 KY Practitioner - Nurse Practitioner 9032642442 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Baptist Health Medical Group IncGroup PAC ID 5597867184, 2,431 clinicians

Practice addresses (Care Compare)

4003 Kresge Way
Suite 400
Louisville, KY 40207-4652
Phone (502) 895-4263

Hospital & facility affiliations

  • Baptist Health Louisville Hospital, Louisville, KY, CCN 180130
  • Baptist Health Hardin Hospital, Elizabethtown, KY, CCN 180012

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4022441KYMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Health Medical Group Inc Nurse Practitioner CurrentSince Sep 4, 2024 Accepting new patients
Baptist Health Medical Group Inc CurrentSince Sep 4, 2024 Accepting new patients

Locations

1901 Campus Pl
Louisville, KY 40299
Phone (502) 253-4911

4003 Kresge Way
Ste 400
Louisville, KY 40207
Phone (502) 895-4263

3900 Kresge Way
Ste 41
Louisville, KY 40207
Phone (502) 896-1313

Organizations & group practices 2

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 2

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": "1692748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725408000000",
    "number": "1174307623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 CAMPUS PL",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402992308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4003 KRESGE WAY STE 400",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074652",
            "telephone_number": "502-895-7265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAAK-JOHNSTON",
        "first_name": "TORI",
        "name_prefix": "Ms.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-23",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "4022441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.