NPIMap

Individual provider Active NPI

Malisica T Brunner, MSN APRN FNP-C

  • Family Nurse Practitioner
  • Shepherdsville, KY
National Provider Identifier
1508536368
Registry record updated Jul 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
3016567 Issued in KY
Practice address
1903 W Hebron LN
Shepherdsville, KY 40165-7425
Phone
(502) 367-3360
NPI assigned
Sep 14, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 3016567 KY Primary

Addresses

Primary practice location

1903 W Hebron LN
Shepherdsville, KY 40165-7425

Mailing address

PO Box 909
Louisville, KY 40201-0909
Phone (502) 367-3360

Other practice location 1

901 S 4th St
Louisville, KY 40203-2188
Phone (502) 585-9911

Other identifiers 1

IdentifierTypeStateIssuer
7100795200MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220128001521 KY Practitioner - Nurse Practitioner 3072905868 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Louisville Physicians IncGroup PAC ID 3476725599, 1,438 clinicians

Practice addresses (Care Compare)

1903 W Hebron LN
Shepherdsville, KY 40165-7425
Phone (502) 852-5341

Hospital & facility affiliations

  • UOFL HEALTH - JEWISH HOSPITAL and Mary & Elizabeth Hospital Hospital, Louisville, KY, CCN 180040

Merit-based Incentive Payment System (MIPS)

Final score
78.96 of 100Reported as group
Quality
56.12
Promoting interoperability
100
Improvement activities
40
Cost
73.73

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing

State licenses

LicenseStateTypeSpecialty
3016567KYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Louisville Physicians, Inc. Family Medicine Current Accepting new patients
University of Louisville Physicians Inc. CurrentSince Aug 1, 2024 Accepting new patients
University of Louisville Physicians, Inc. CurrentSince Aug 1, 2024 Accepting new patients
Clear Path Recovery Solutions CurrentSince Jan 25, 2025 Accepting new patients
Uofl Health-Louisville Inc Past Accepting new patients
University of Louisville Physicians, Inc. Past Accepting new patients

Locations

7752 Solution Ctr
Chicago, IL 60677

1939 Goldsmith Ln
Ste 24
Louisville, KY 40218
Phone (502) 298-1204

1939 Goldsmith Ln
Ste 20
Louisville, KY 40218
Phone (502) 365-1484

571 S Floyd St
Louisville, KY 40202
Phone (502) 561-2700

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

1903 W Hebron Ln
Shepherdsvlle, KY 40165
Phone (502) 587-4421

Organizations & group practices 6

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 22

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1631577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721692800000",
    "number": "1508536368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 909",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402010909",
            "telephone_number": "502-367-3360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1903 W HEBRON LN",
            "city": "SHEPHERDSVILLE",
            "state": "KY",
            "postal_code": "401657425",
            "telephone_number": "502-367-3360"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "901 S 4th St",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402032188",
            "country_code": "US",
            "telephone_number": "502-585-9911",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUNNER",
        "first_name": "MALISICA",
        "middle_name": "T",
        "credential": "MSN APRN FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-14",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3016567",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100795200",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shepherdsville, KY

Sources for this page

Verify at the official NPI Registry.