Melissa Dawn Slack, APRN
Individual provider Active NPI Family Medicine Physician · Brookville, OH
NPI 1265103261 · NPPES record last updated Sep 21, 2021
Key facts
- NPI
- 1265103261
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- CNP.0029805 (OH)
- Practice address
- 12134 Old Dayton Rd
Brookville, OH 45309-8361 - Phone
- (937) 416-8874
- NPI assigned
- Sep 21, 2021
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Healogics Specialty Physicians of Ohio, LLC
Practice addresses (Care Compare)
3130 N Country Rd
25A
Troy, OH 45373-1337
Phone (937) 440-7888
Hospital & facility affiliations
- Fidelity Health Care
- Upper Valley Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OH, IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211206001404 | OH | Practitioner - Nurse Practitioner | 7810884764 | Reassigns benefits to 3 organizations |
| I20231213000303 | IN | Practitioner - Nurse Practitioner | 7810884764 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CNP.0029805 | OH | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Healogics Specialty Physicians of Indiana, LLC | Family Medicine | Current |
Accepting new patients |
| Healogics Specialty Physicians of Ohio, LLC | Family Medicine | Current |
Accepting new patients |
Locations
5220 Belfort Rd
Ste 150
Jacksonville, FL 32256
Phone (904) 446-3519
133 W Market St
Indianapolis, IN 46204
Phone (312) 505-7514
1907 W Sycamore St
Kokomo, IN 46901
Phone (765) 452-5611
1606 N 7th St
Terre Haute, IN 47804
Phone (812) 238-7523
1010 Cereal Ave
Hamilton, OH 45013
Phone (513) 281-8827
3130 N County Road 25A
Ste 1
Troy, OH 45373
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | CNP.0029805 | OH | Yes |
Addresses
Primary practice location
12134 Old Dayton Rd
Brookville, OH 45309-8361
Mailing address
12134 Old Dayton Rd
Brookville, OH 45309-8361
Phone (937) 416-8874
Other providers in Brookville, OH
- Scott L Hora OD LLC
- Elaine Kay Scott
- Anthony H Shaffer
- Randall R Shaffer
- Tonya Lynn Singleton
- Deborah Dawn Smith
- Southwest Ohio Home Care LLC
- Brian Keith Stinson Jr.
- Studebaker Family Practice Inc.
- Jeffrey Bruce Studebaker
All providers in Brookville, OH · Family Medicine Physician in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 21, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.