Carolyn R Fegenbush, ARNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

71001579A Issued in IN

Practice address

1802 E 10TH St
Jeffersonville, IN 47130-6016

Phone

(812) 288-2488

Fax

(770) 573-9513

NPI assigned

Jul 6, 2006

Sex

Female

Sole proprietor

No

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.

• North Clark Medical Group LLC

  • General Practice Physician
  • Jeffersonville, IN
  • NPI 1376095711
  Medicare reassignment Care Compare group NPD ADDICTION MEDICINE · IN · KY
• Zilmed LLC

  • Family Medicine Physician
  • Jeffersonville, IN
  • NPI 1083131957
  Medicare reassignment Care Compare group IN · KY
• Nazareth Home, Inc.

  • Skilled Nursing Facility
  • Louisville, KY
  • NPI 1205292893
  NPD (past)

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Nazareth Home Inc

  • Skilled Nursing Facility
  • Louisville, KY
  • NPI 1346312824
  CMS ownership CORPORATE DIRECTOR
• Nazareth Home, Inc.

  • Skilled Nursing Facility
  • Louisville, KY
  • NPI 1205292893
  CMS ownership CORPORATE DIRECTOR

Specialty

Nurse Practitioner

Education

Other, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Clark Medical Group LLC 21 clinicians

Zilmed LLC 3 clinicians

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in IN, KY2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 8, 2021.

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636329600000",
    "number": "1629009790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 MARKET ST STE 101",
            "city": "CHARLESTOWN",
            "state": "IN",
            "postal_code": "471119535",
            "telephone_number": "812-503-5100",
            "fax_number": "770-573-9513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1802 E 10TH ST",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471306016",
            "telephone_number": "812-288-2488",
            "fax_number": "770-573-9513"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "815 Short St",
            "address_purpose": "LOCATION",
            "city": "Charlestown",
            "state": "IN",
            "postal_code": "471111241",
            "country_code": "US",
            "telephone_number": "812-503-5100",
            "fax_number": "770-573-9513",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1804 E 10th St",
            "address_purpose": "LOCATION",
            "city": "Jeffersonville",
            "state": "IN",
            "postal_code": "471306016",
            "country_code": "US",
            "telephone_number": "812-288-2488",
            "fax_number": "770-573-9513",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FEGENBUSH",
        "first_name": "CAROLYN",
        "middle_name": "R",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-06",
        "last_updated": "2021-11-08",
        "certification_date": "2021-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "IN",
            "license": "71001579A",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71001579A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT ADVANTAGE",
            "identifier": "2823492000",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200451720",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT",
            "identifier": "50014111",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78010824",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00424435",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Family Health Center of Clark County, Inc.
• Family Medicine of Southern Indiana
• Megan Farmer, RBT
• Lindasue Farrell, LCSW
• Jena Fath, RBT
• Diane Ferree
• Asia Fields
• Joyce Audrey Fields
• Madison J Fields, SLP
• Ann Lauren Fiepke

• All providers in Jeffersonville, IN
• Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• 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.