Individual provider Active NPI

Michelle Eileen Elisburg, MD

  • Pediatrics Physician
  • Louisville, KY
National Provider Identifier
1679572309
Registry record updated Apr 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
39801 Issued in KY
Practice address
2215 Portland Ave
Louisville, KY 40212-1033
Phone
(502) 774-8631
Fax
(502) 776-8912
NPI assigned
Jul 15, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 39801 KY Primary

Addresses

Primary practice location

2215 Portland Ave
Louisville, KY 40212-1033

Mailing address

PO Box 950244
Louisville, KY 40295-0244
Phone (502) 953-4700

Other identifiers 1

IdentifierTypeStateIssuer
64114457MedicaidKY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051207000639 KY Practitioner - Pediatric Medicine 9739146622 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
23252SCMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Centers, Inc. Current Accepting new patients
Family Health Centers, Inc. CurrentSince Dec 1, 2010 Accepting new patients
Family Health Centers, Inc. CurrentSince Dec 1, 2010 Accepting new patients
Family Health Centers, Inc. Current Accepting new patients
Family Health Centers, Inc. Current Accepting new patients
Family Health Centers, Inc. Current Accepting new patients
Family Health Centers, Inc. Past Accepting new patients
Family Health Centers, Inc. Past Accepting new patients
Family Health Centers Inc Past Accepting new patients
Family Health Centers, Inc. Past Accepting new patients
Family Health Centers, Inc. Past Accepting new patients
Family Health Centers, Inc. Past Accepting new patients

Locations

1000 Neighborhood Pl
Fairdale, KY 40118
Phone (502) 361-2381

4805 Southside Dr
Louisville, KY 40214
Phone (502) 772-8860

120 W Broadway
Louisville, KY 40202
Phone (502) 772-8662

4803 Southside Dr
Louisville, KY 40214
Phone (502) 363-8606

2215 Portland Ave
Louisville, KY 40212
Phone (502) 774-8631

4615 Taylor Blvd
Louisville, KY 40215
Phone (502) 366-4747

2500 W Market St
Louisville, KY 40212
Phone (502) 778-0084

4112 Taylor Blvd
Louisville, KY 40215
Phone (502) 366-4747

4100 Taylor Blvd
Louisville, KY 40215
Phone (502) 361-2381

712 E Muhammad Ali Blvd
Louisville, KY 40202
Phone (502) 568-6972

834 E Broadway
Louisville, KY 40204
Phone (502) 583-1981

Interoperability endpoints

  • Direct secure messaging: michelle.elisburg@fhci.eclinicaldirectplus.com

Organizations & group practices 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1121385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618272000000",
    "number": "1679572309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 950244",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402950244",
            "telephone_number": "502-953-4700",
            "fax_number": "502-776-8912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2215 PORTLAND AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402121033",
            "telephone_number": "502-774-8631",
            "fax_number": "502-776-8912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELISBURG",
        "first_name": "MICHELLE",
        "middle_name": "EILEEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-15",
        "last_updated": "2021-04-13",
        "certification_date": "2021-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "39801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64114457",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.