Active NPI
Rose Jackson Buckley, HSPP
- Psychologist
- Indianapolis, IN
National Provider Identifier
1609023902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 20043544B
- Practice address
- 3921 N Meridian St Ste 200
Indianapolis, IN 46208-4064 - Phone
- (812) 332-1262
- NPI assigned
- Aug 19, 2008
- Last updated
- Oct 20, 2022
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | |||
| Psychologist | 103T00000X | 20043544B | IN | Primary |
Addresses
Primary practice location
3921 N Meridian St Ste 200
Indianapolis, IN 46208-4064
Mailing address
5134 McHenry LN
Indianapolis, IN 46228-2368
Phone (812) 322-5620
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | TherapyNotes | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20043544B | IN | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Catholic Charities | Past | Accepting new patients |
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": "1219104000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666224000000",
"number": "1609023902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5134 MCHENRY LN",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462282368",
"telephone_number": "812-322-5620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3921 N MERIDIAN ST STE 200",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462084064",
"telephone_number": "812-332-1262"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUCKLEY",
"first_name": "ROSE",
"middle_name": "JACKSON",
"name_prefix": "Dr.",
"credential": "HSPP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-08-19",
"last_updated": "2022-10-20",
"certification_date": "2022-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": null,
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "IN",
"license": "20043544B",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "TherapyNotes",
"affiliation": "N",
"endpointDescription": "EMR",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "3921 N Meridian St Ste 200",
"city": "Indianapolis",
"state": "IN",
"country_code": "US",
"postal_code": "462084064",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}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 Oct 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.