Shelby Diachenko Jouppi, PT, DPT, EP-C

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

P20222 Issued in NC

Practice address

2400 Park Rd Ste G-1
Charlotte, NC 28203-6072

Phone

(704) 269-8874

NPI assigned

Feb 22, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Full Circle Physical Therapy LLCGroup PAC ID 0941691612, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Full Circle Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Charlotte, NC
  • NPI 1265003289

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Moriarty Physical Therapy Inc

  • Physical Therapist
  • Raleigh, NC
  • NPI 1447715982
  NPD (past)

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

{
    "created_epoch": "1613952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656547200000",
    "number": "1609460518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 PARK RD STE G-1",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282036072",
            "telephone_number": "704-269-8874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 PARK RD STE G-1",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282036072",
            "telephone_number": "704-269-8874"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15825 Ballantyne Medical Pl Ste 120",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282774790",
            "country_code": "US",
            "telephone_number": "704-323-3409",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOUPPI",
        "first_name": "SHELBY",
        "middle_name": "DIACHENKO",
        "credential": "PT, DPT, EP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-22",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P20222",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NSC #",
            "identifier": "0397730019",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "shelby@cltfullcirclept.com",
            "affiliation": "N",
            "endpointDescription": "work",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2400 Park Rd Ste G-1",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282036072",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Physical Therapist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2022; 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.