Active NPI
Dr Lullaby LLC
- Clinic/Center
- Highland, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- Legal business name
- DR LULLABY LLC
- Practice address
- 9445 Indianapolis Blvd
Highland, IN 46322-2648 - Phone
- (844) 475-3379
- NPI assigned
- Jan 24, 2023
- Last updated
- Jan 27, 2023
- Organization subpart
- Yes
- Parent organization
- DR LULLABY LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Lisa Ann Medalie
- Title
- Ceo
- Phone
- (619) 997-5759
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | |||
| Clinic/Center | 261Q00000X | Primary |
Addresses
Primary practice location
9445 Indianapolis Blvd
Highland, IN 46322-2648
Mailing address
1440 W Taylor St Ste 556
Chicago, IL 60607-4623
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230331002051 | IN | Part B Supplier - Clinic/Group Practice | 9931507290 | Practice locations: Highland, IN |
Other NPIs with the same Medicare PAC ID 6
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider Directory- Part of
- Drlullaby LLC
Member organizations 1
Organizations listed as members of this organization in the National Provider Directory.
Locations
9445 Indianapolis Blvd
Highland, IN 46322
Phone (765) 382-9629
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Clinical Neuropsychologist
- Evanston, IL
- NPI 1609175744
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674518400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1674777600000",
"number": "1679289615",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1440 W TAYLOR ST STE 556",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606074623"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9445 INDIANAPOLIS BLVD",
"city": "HIGHLAND",
"state": "IN",
"postal_code": "463222648",
"telephone_number": "844-475-3379"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DR LULLABY LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "DR LULLABY LLC",
"enumeration_date": "2023-01-24",
"last_updated": "2023-01-27",
"certification_date": "2023-01-27",
"status": "A",
"authorized_official_last_name": "MEDALIE",
"authorized_official_first_name": "LISA",
"authorized_official_middle_name": "ANN",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "619-997-5759"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": null,
"license": null,
"primary": false
},
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Highland, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.