Individual provider Active NPI

Kim M Huckaby, NP

  • Family Nurse Practitioner
  • Indianapolis, IN
National Provider Identifier
1861815912
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71004769A Issued in IN
Practice address
8177 Clearvista Pkwy
Indianapolis, IN 46256-1662
Phone
(317) 621-7801
Fax
(317) 621-7205
NPI assigned
Jan 27, 2014
Last updated
Nov 27, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71004769A IN Primary

Addresses

Primary practice location

8177 Clearvista Pkwy
Indianapolis, IN 46256-1662

Mailing address

6626 E 75TH St
Suite 500
Indianapolis, IN 46250-2890

Other identifiers 2

IdentifierTypeStateIssuer
PO1307685OtherINMEDICAID RR PTAN
201210360MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address khuckaby17214@eCommunityDirect.com Community Physicians of Indiana Inc

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20140324001269 IN Practitioner - Nurse Practitioner 0648401299 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Community Physicians of Indiana IncGroup PAC ID 1759416662, 1,569 clinicians

Practice addresses (Care Compare)

1500 N Ritter Ave
Community Hospital East
Indianapolis, IN 46219-3027
Phone (317) 355-1411

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
71004769AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Physicians of Indiana Inc CurrentSince Feb 10, 2014 Accepting new patients
Community Physicians of Indiana Inc CurrentSince Feb 10, 2014 Accepting new patients

Locations

5819 Reliable Pkwy
Chicago, IL 60686

6626 E 75th St
Ste 500
Indianapolis, IN 46250
Phone (317) 621-7547

1500 N Ritter Ave
Indianapolis, IN 46219
Phone (317) 355-5041

8177 Clearvista Pkwy
Indianapolis, IN 46256
Phone (317) 621-7800

7120 Clearvista Dr
Ste 4000
Indianapolis, IN 46256
Phone (317) 621-7444

Interoperability endpoints

  • Direct secure messaging: khuckaby17214@ecommunitydirect.com

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1390780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1861815912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6626 E 75TH ST",
            "address_2": "SUITE 500",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8177 CLEARVISTA PKWY",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462561662",
            "telephone_number": "317-621-7801",
            "fax_number": "317-621-7205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUCKABY",
        "first_name": "KIM",
        "middle_name": "M",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-27",
        "last_updated": "2023-11-27",
        "certification_date": "2020-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71004769A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID RR PTAN",
            "identifier": "PO1307685",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201210360",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "khuckaby17214@eCommunityDirect.com",
            "affiliation": "Y",
            "affiliationName": "Community Physicians of Indiana Inc",
            "address_1": "8177 Clearvista Pkwy",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462561662",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.