NPIMap

Individual provider Active NPI

Kelsey Denise Menegotto, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Indianapolis, IN
National Provider Identifier
1932525136
Registry record updated Jun 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
12013532A Issued in IN
Practice address
777 Beachway Dr Ste 202
Indianapolis, IN 46224-7877
Phone
(317) 297-1007
Fax
(317) 405-8694
NPI assigned
Mar 12, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 22, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 9892 KY
Oral & Maxillofacial Surgery (D.M.D.)Group: 193400000X SINGLE SPECIALTY GROUP 204E00000X 9892 KY
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X 12013532A IN Primary

Addresses

Primary practice location

777 Beachway Dr Ste 202
Indianapolis, IN 46224-7877

Mailing address

10972 Allisonville Rd Ste 110
Fishers, IN 46038-2639
Phone (270) 314-6363

Other practice location 1

1040 Patrick Pl Ste A
Brownsburg, IN 46112-2432
Phone (317) 297-1007

Other names 1

  • Mrs. Kelsey Denise Johnson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Oct 2, 2024 through Oct 2, 2026

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9892KYMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Kentucky Center for Oral & Maxillofacial Surgery Single Specialty Past Accepting new patients
Kentucky Center for Oral & Maxillofacial Surgery PSC Oral and Maxillofacial Surgery Past Accepting new patients
Kentucky Center for Oral & Maxillofacial Surgery PSC Dentist Past Accepting new patients
Kentucky Center for Oral & Maxillofacial Surgery Single Specialty Past Accepting new patients
Kentucky Center for Oral & Maxillofacial Surgery Single Specialty Past Accepting new patients
Kentucky Center for Oral & Maxillofacial Surgery PSC Oral and Maxillofacial Surgery Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: kmenegotto483584@ecommunitydirect.com

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1394582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624320000000",
    "number": "1932525136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10972 ALLISONVILLE RD STE 110",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460382639",
            "telephone_number": "270-314-6363",
            "fax_number": "317-913-2360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 BEACHWAY DR STE 202",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462247877",
            "telephone_number": "317-297-1007",
            "fax_number": "317-405-8694"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1040 Patrick Pl Ste A",
            "address_purpose": "LOCATION",
            "city": "Brownsburg",
            "state": "IN",
            "postal_code": "461122432",
            "country_code": "US",
            "telephone_number": "317-297-1007",
            "fax_number": "317-405-8694",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MENEGOTTO",
        "first_name": "KELSEY",
        "middle_name": "DENISE",
        "name_prefix": "Mrs.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-03-12",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "9892",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "KY",
            "license": "9892",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IN",
            "license": "12013532A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELSEY",
            "last_name": "JOHNSON",
            "middle_name": "DENISE",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.