Marlyssa Rae Fillmore, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

20043326A Issued in IN

Practice address

4980 Hunters Run
Columbus, IN 47201-8499

Phone

(812) 552-1499

NPI assigned

Jul 13, 2019

Last updated

Oct 23, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Be Authentic Indy LLCGroup PAC ID 7618341496, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mfillmore523139@direct.franciscanalliance.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Be Authentic Indy LLC

  dba Ellie Mental Health

  • Clinical Social Worker
  • Indianapolis, IN
  • NPI 1841901022
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1562976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729641600000",
    "number": "1831741461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4020 W GOELLER BLVD",
            "address_2": "ELLIE MENTAL HEALTH",
            "city": "COLUMBUS",
            "state": "IN",
            "postal_code": "472018499",
            "telephone_number": "812-552-1499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4980 HUNTERS RUN",
            "city": "COLUMBUS",
            "state": "IN",
            "postal_code": "472018499",
            "telephone_number": "812-552-1499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FILLMORE",
        "first_name": "MARLYSSA",
        "middle_name": "RAE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-13",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "20043326A",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20043326A",
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "IN",
            "license": "20043326A",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "IN",
            "license": "10228724",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mfillmore523139@Direct.FranciscanAlliance.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "5230 E Stop 11 Rd Ste 250",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462376399",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Katherine E. Ferry, DDS
• Reagan Fickert
• Denise C Fields, PHARMD
• Mason Fields, RBT
• Shelby Fields, RBT
• Kelsey Marie Finch, PHARMD
• Elizabeth Weihe Finke, SLP
• Katie Elizabeth Finke, DPT
• Austin Douglas Finney
• First Choice Physical Therapy of Columbus, LLC

• Psychologist in Columbus, IN
• Providers in Columbus, IN by specialty
• Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2024; 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.