Active NPI
Heidi Fuller
- Point of Service
- Louisville, KY
National Provider Identifier
1730713173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Point of Service
- Practice address
- 12121 Shelbyville Rd Ste 101
Louisville, KY 40243-1094 - Phone
- (502) 341-1599
- NPI assigned
- Feb 25, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Point of Service | 305S00000X | Primary |
Addresses
Primary practice location
12121 Shelbyville Rd Ste 101
Louisville, KY 40243-1094
Mailing address
12121 Shelbyville Rd Ste 101
Louisville, KY 40243-1094
Phone (502) 341-1599
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 965136 | Other | MEDICAL SERVICES | |
| 000965136 | Other | KY | CRANIAL PROSTHESIS |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | awakenshop.com | Health Information Exchange (HIE) |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1582588800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1582588800000",
"number": "1730713173",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12121 SHELBYVILLE RD STE 101",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402431094",
"telephone_number": "502-341-1599"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12121 SHELBYVILLE RD STE 101",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402431094",
"telephone_number": "502-341-1599"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "HEIDI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-02-25",
"last_updated": "2020-02-25",
"certification_date": "2020-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "305S00000X",
"taxonomy_group": "",
"desc": "Point of Service",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL SERVICES",
"identifier": "965136",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CRANIAL PROSTHESIS",
"identifier": "000965136",
"state": "KY"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "awakenshop.com",
"affiliation": "N",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"useOtherDescription": "email",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "web",
"address_1": "12121 Shelbyville Rd Ste 101",
"city": "Louisville",
"state": "KY",
"country_code": "US",
"postal_code": "402431094",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.