Active NPI
Heather Short
- Social Worker
- Indianapolis, IN
National Provider Identifier
1386043727
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 33006965A
- Practice address
- 8320 Madison Ave
Indianapolis, IN 46227-6066 - Phone
- (317) 882-5122
- Fax
- (317) 888-8642
- NPI assigned
- Aug 21, 2014
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 33006965A | IN | Primary |
Addresses
Primary practice location
8320 Madison Ave
Indianapolis, IN 46227-6066
Mailing address
8320 Madison Ave
Indianapolis, IN 46227-6066
Phone (317) 882-5122
Other names 1
- Heather Nicodemus
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2024 through Jul 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33006965A | IN | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1408579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670803200000",
"number": "1386043727",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8320 MADISON AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462276066",
"telephone_number": "317-882-5122",
"fax_number": "317-888-8642"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8320 MADISON AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462276066",
"telephone_number": "317-882-5122",
"fax_number": "317-888-8642"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHORT",
"first_name": "HEATHER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-08-21",
"last_updated": "2022-12-12",
"certification_date": "2022-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IN",
"license": "33006965A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "HEATHER",
"last_name": "NICODEMUS",
"code": "1",
"type": "Former Name"
}
]
}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 Dec 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.