Kathleen Kelli Carroll, NP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

71007306A Issued in IN

Practice address

8424 Naab Rd Ste 1L
Indianapolis, IN 46260-1954

Phone

(317) 338-7780

NPI assigned

May 30, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kathleen Weaver Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

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.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Vincent Medical Group IncGroup PAC ID 7012047640, 728 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension St Vincent Hospital Hospital, Indianapolis, IN, CCN 150084

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kathleen.weaver.1@7598.direct.athenahealth.com

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.

• St. Vincent Medical Group, Inc.

  • Orthopaedic Surgery Physician
  • Winchester, IN
  • NPI 1144513375
  Medicare reassignment Care Compare group NPD
• St. Vincent Medical Group, Inc.

  • Internal Medicine Physician
  • Carmel, IN
  • NPI 1811881527
  NPD
• St Vincent Medical Group Inc

  • Cardiovascular Disease Physician
  • Indianapolis, IN
  • NPI 1558686436
  NPD (past)

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

• St. Vincent Hospital & Health Care Center, Inc.

  • General Acute Care Hospital
  • Indianapolis, IN
  • NPI 1306898960
  Care Compare affiliation
• St. Vincent Hospital & Health Care Center, Inc.

  • General Acute Care Hospital
  • Avon, IN
  • NPI 1851833230
  Care Compare affiliation

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

{
    "created_epoch": "1496102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696982400000",
    "number": "1811425382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8424 NAAB RD STE 1L",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462601954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8424 NAAB RD STE 1L",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462601954",
            "telephone_number": "317-338-7780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "KATHLEEN",
        "middle_name": "KELLI",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-30",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IN",
            "license": "71007306A",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IN",
            "license": "71007306A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kathleen.weaver.1@7598.direct.athenahealth.com",
            "affiliation": "Y",
            "affiliationName": "St. Vincent Medical Group, Inc.",
            "address_1": "8424 Naab Rd Ste 1L",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462601954",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KATHLEEN",
            "last_name": "WEAVER",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Chase Mitchell Carroll, M.D.
• Deborah A Carroll, PT
• Jacqueline Carroll, LMHC
• Joseph Charles Carroll IV, D.O
• Kacey Carroll, PHARMD
• Katlyn Carroll, MA, BCBA
• Kimberly Sue Carroll
• Lisa M Carroll
• Mackenzie Kate Carroll, OTD
• Michael C Carroll, DPM

• Gerontology Nurse Practitioner in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Gerontology Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; 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.