NPIMap

Individual provider Active NPI

Natalie Wise Jeffries, PA-C

  • Physician Assistant
  • Louisville, KY
National Provider Identifier
1780139295
Registry record updated Jul 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
4331 Churchman Ave
Ste 101
Louisville, KY 40215
Phone
(502) 364-0902
Fax
(502) 364-0099
NPI assigned
Aug 25, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

4331 Churchman Ave
Ste 101
Louisville, KY 40215

Mailing address

4331 Churchman Ave
Ste 101
Louisville, KY 40215-1164
Phone (502) 364-0902

Other identifiers 2

IdentifierTypeStateIssuer
7100437600MedicaidKY
000001040338OtherKYANTHEM

Other names 1

  • Natalie D Wise Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161005003095 KY Practitioner - Physician Assistant 9436447596 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Live Well Orthopedic Care LLCGroup PAC ID 9739416611, 4 clinicians

Practice addresses (Care Compare)

8442 Dixie Hwy
Louisville, KY 40258-1140
Phone (502) 286-4644

Hospital & facility affiliations

  • Vna Health at Home Home health agency, Louisville, KY, CCN 187000
  • Norton Hospitals, Inc Hospital, Louisville, KY, CCN 180088

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Organizations & group practices 1

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.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1472083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532908800000",
    "number": "1780139295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4331 CHURCHMAN AVE",
            "address_2": "STE 101",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402151164",
            "telephone_number": "502-364-0902",
            "fax_number": "502-364-0099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4331 CHURCHMAN AVE",
            "address_2": "STE 101",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40215",
            "telephone_number": "502-364-0902",
            "fax_number": "502-364-0099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEFFRIES",
        "first_name": "NATALIE",
        "middle_name": "WISE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-25",
        "last_updated": "2018-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100437600",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000001040338",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NATALIE",
            "last_name": "WISE",
            "middle_name": "D",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.