Individual provider Active NPI

Melissa M Dicke

  • Physical Therapist
  • Carmel, IN
National Provider Identifier
1891018073
Registry record updated Jul 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
580 E Carmel Dr Ste 208
Carmel, IN 46032
Phone
(317) 325-8860
NPI assigned
Mar 2, 2010
Last updated
Jul 30, 2018By the provider in NPPES
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
Physical Therapist 225100000X Primary

Addresses

Primary practice location

580 E Carmel Dr Ste 208
Carmel, IN 46032

Mailing address

580 E Carmel Dr Ste 208
Carmel, IN 46032-3314
Phone (317) 325-8860

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140819001497 IN Practitioner - Physical Therapist in Private Practice 1658558119 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Practice roles

OrganizationSpecialtyStatusNew patients
Elite Therapy Corp Physical Therapist CurrentSince Feb 19, 2019 Accepting new patients
Elite Therapy Corp CurrentSince Sep 1, 2019 Accepting new patients
Elite Home Rehab and Healthcare Corp CurrentSince Jun 9, 2016 Accepting new patients

Locations

580 E Carmel Dr
Ste 208
Carmel, IN 46032
Phone (317) 325-8860

401 Reynolds Dr
Kokomo, IN 46902
Phone (317) 453-0802

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Elite Home Rehab and Healthcare CorpCarmel, IN, CCN 157692 Home health agency 5% Or Greater Direct Ownership Interest (100%)
Corporate Officer (75%)
W-2 Managing Employee (100%)
Jun 9, 2016
Jun 9, 2016
Jun 9, 2016

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1267488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532908800000",
    "number": "1891018073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 E CARMEL DR STE 208",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460323314",
            "telephone_number": "317-325-8860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 E CARMEL DR STE 208",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "46032",
            "telephone_number": "317-325-8860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKE",
        "first_name": "MELISSA",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-02",
        "last_updated": "2018-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carmel, IN

Sources for this page

Verify at the official NPI Registry.