Individual provider Active NPI

Denise A Bickley, AU.D.

  • Audiologist
  • Fort Wayne, IN
National Provider Identifier
1194701300
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
23002323A Issued in IN
Practice address
9604 Coldwater Rd Ste 101
Fort Wayne, IN 46825-2096
Phone
(260) 387-5820
Fax
(855) 828-7823
NPI assigned
Dec 20, 2005
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 23002323A IN Primary

Addresses

Primary practice location

9604 Coldwater Rd Ste 101
Fort Wayne, IN 46825-2096

Mailing address

9604 Coldwater Rd Ste 101
Fort Wayne, IN 46825-2096
Phone (260) 387-5820

Other practice location 1

6301 University Commons Ste 360
South Bend, IN 46635-3500
Phone (260) 387-5820

Other identifiers 1

IdentifierTypeStateIssuer
200463510MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081209000104 IN Practitioner - Qualified Audiologist 0941361075 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Indiana University School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ear Clinic of IndianaGroup PAC ID 9234310350, 2 clinicians

Practice addresses (Care Compare)

9604 Coldwater Rd
Suite 103
Fort Wayne, IN 46825-2096
Phone (260) 387-5820

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
23002323AINMDAudiologist

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/20253/brand/1/csg/1/fhir/r4

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1135036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1194701300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9604 COLDWATER RD STE 101",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468252096",
            "telephone_number": "260-387-5820",
            "fax_number": "855-828-7823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9604 COLDWATER RD STE 101",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468252096",
            "telephone_number": "260-387-5820",
            "fax_number": "855-828-7823"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6301 University Commons Ste 360",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466353500",
            "country_code": "US",
            "telephone_number": "260-387-5820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BICKLEY",
        "first_name": "DENISE",
        "middle_name": "A",
        "credential": "AU.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-20",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "IN",
            "license": "23002323A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200463510",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.