Active NPI
Carly Clevenger
- Physical Therapist
- Noblesville, IN
National Provider Identifier
1861054934
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 296696
- Practice address
- 14379 Black Farm Dr
Noblesville, IN 46060-7261 - Phone
- (219) 776-5668
- NPI assigned
- Jun 28, 2019
- Last updated
- Oct 27, 2024
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 296696 | CA | Primary |
Addresses
Primary practice location
14379 Black Farm Dr
Noblesville, IN 46060-7261
Mailing address
14379 Black Farm Dr
Noblesville, IN 46060-7261
Phone (219) 776-5668
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220712002762 | IN | Practitioner - Physical Therapist in Private Practice | 6103152145 | Practice locations: Fishers, IN |
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2019
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
8100 E 106TH St
Suite 260 Room 7
Fishers, IN 46038-2542
Phone (219) 776-5668
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729987200000",
"number": "1861054934",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14379 BLACK FARM DR",
"city": "NOBLESVILLE",
"state": "IN",
"postal_code": "460607261",
"telephone_number": "219-776-5668"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14379 BLACK FARM DR",
"city": "NOBLESVILLE",
"state": "IN",
"postal_code": "460607261",
"telephone_number": "219-776-5668"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEVENGER",
"first_name": "CARLY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-06-28",
"last_updated": "2024-10-27",
"certification_date": "2024-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "296696",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Noblesville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.