Active NPI
Shelly Mitchell Rakutt, MD
- Anesthesiology Physician
- Louisville, KY
National Provider Identifier
1174500318
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 28051
- Practice address
- 1 Audubon Plaza Dr
Louisville, KY 40217-1318 - Phone
- (502) 636-7449
- Fax
- (502) 636-7950
- NPI assigned
- Dec 29, 2005
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 28051 | KY | Primary |
Addresses
Primary practice location
1 Audubon Plaza Dr
Louisville, KY 40217-1318
Mailing address
PO Box 950195
Dept 86236
Louisville, KY 40295-0195
Phone (502) 473-2100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64280514 | Medicaid | KY |
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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040611000016 | KY | Practitioner - Anesthesiology | 5092798991 | Reassigns benefits to 2 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Anesthesiology
- Education
- University of Louisville School of Medicine, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Professional Anesthesia Services of Kentucky PLLC
Practice addresses (Care Compare)
200 E Chestnut St
Louisville, KY 40202-1831
Phone (502) 629-8000
Hospital & facility affiliations
- Norton Hospitals, Inc
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28051 | KY | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Professional Anesthesia Services of Kentucky PLLC | Anesthesiology | Current | Accepting new patients |
| Universal Anesthesia Services LLC | Anesthesiology | Current | Accepting new patients |
| One Anesthesia PLLC | Anesthesiology | Past | Accepting new patients |
| Norton Anesthesia Services | Anesthesiology | Past | Accepting new patients |
| Anesthesiology Consultants Enterprises, PLLC | Anesthesiology | Past | Accepting new patients |
Locations
3423 Solutions Ctr
Chicago, IL 60677
200 E Chestnut St
Louisville, KY 40202
Phone (502) 446-8000
231 E Chestnut St
Louisville, KY 40202
Phone (502) 852-8500
4000 Kresge Way
St Matthews, KY 40207
Phone (502) 459-7902
Organizations & group practices 5
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.
-
- Anesthesiology Physician
- Louisville, KY
- NPI 1992212807
Anesthesiology, KY
-
- Anesthesiology Physician
- Louisville, KY
- NPI 1164696282
Anesthesiology, KY
-
- Anesthesiology Physician
- Louisville, KY
- NPI 1427246198
Anesthesiology
Hospital & facility affiliations 14
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": "1135814400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192060800000",
"number": "1174500318",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 950195",
"address_2": "DEPT 86236",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402950195",
"telephone_number": "502-473-2100",
"fax_number": "502-459-6461"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 AUDUBON PLAZA DR",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402171318",
"telephone_number": "502-636-7449",
"fax_number": "502-636-7950"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAKUTT",
"first_name": "SHELLY",
"middle_name": "MITCHELL",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-29",
"last_updated": "2007-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "KY",
"license": "28051",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64280514",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.