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SHIVELY FIRST HEALTH CARE, LLC
NPI 1811775679
Clinic/Center - Rehabilitation, Substance Use Disorder in Louisville, KY

Active since September 21, 2023CLIA 18D2290535 · Waiver
924 E BROADWAY, LOUISVILLE, KY 40204(502) 200-1335(502) 200-8904 Get Directions Write a Review

NPPES record last updated: July 27, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 27, 2026, Jul 17, 2026, Jan 30, 2026 and 4 more (7 updates tracked since 2023).

About Shively First Health Care, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHIVELY FIRST HEALTH CARE, LLC (NPI 1811775679) is a healthcare organization registered as a rehabilitation, substance use disorder in Louisville, Kentucky and active in the NPI registry since September 2023. The organization holds a CLIA Waiver certificate valid through June 24, 2028 and lists Devin Pantess, Chief Operations Officer, as its authorized official.

NPPES Registry Identity

NPI1811775679
Entity TypeOrganization
Primary Taxonomy261QR0405X
Legal Business NameSHIVELY FIRST HEALTH CARE, LLC
Location Address924 E BROADWAYLouisville, KY 40204-1057
Mailing Address924 E BroadwayLouisville, KY 40204-1057 · (502) 200-1335 · Fax (502) 200-8904
Phone(502) 200-1335
Fax(502) 200-8904
Organization SubpartNo
Authorized OfficialDevin PantessChief Operations Officer · (502) 259-8811
Enumeration DateSeptember 21, 2023
Last NPPES UpdateJuly 27, 20267 updates tracked since enumeration
NPPES CertifiedJuly 27, 2026
✔ NPI 1811775679 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyClinic/Center · Rehabilitation, Substance Use DisorderAmbulatory Health Care Facilities
Taxonomy Code261QR0405X
Also ListedCommunity/Behavioral HealthTaxonomy 251S00000X
Also ListedSubstance Abuse Rehabilitation FacilityTaxonomy 324500000X
924 E BROADWAY, Louisville, KY 40204
Open in Google Maps ↗

Other Identifiers 1

Medicaid7100912570KY

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Shively First Health Care, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Shively First Health Care, LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Mary Pantess, NP
Nurse Practitioner
NPI 1043996911
924 E BROADWAY
Louisville, KY 40204
(502) 200-1335
✔ PECOSSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 18D2290535

Shively First Health Care LLC · Louisville, KY
Active · expires Jun 24, 2028
CLIA Number18D2290535
Laboratory TypePhysician Office
Certificate Effective DateJune 25, 2026
Certificate Expiration DateJune 24, 2028
Laboratory DirectorMs. Mary L. Pantess
Laboratory Phone(502) 200-1335
Laboratory LocationShively First Health Care LLC924 E Broadway, Louisville, KY 40204
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shively First Health Care, LLC's NPI number?

The NPI number for Shively First Health Care, LLC is 1811775679. It was assigned to this organization in the NPPES registry on September 21, 2023.

Where is Shively First Health Care, LLC located?

Shively First Health Care, LLC is located at 924 E Broadway, Louisville, KY 40204. The listed phone number is (502) 200-1335.

What is Shively First Health Care, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rehabilitation, Substance Use Disorder, with taxonomy code 261QR0405X.

Is Shively First Health Care, LLC enrolled in Medicare?

Yes. Shively First Health Care, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Shively First Health Care, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Shively First Health Care, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Shively First Health Care, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 18D2290535) is associated with this NPI, valid through June 24, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Shively First Health Care, LLC was last updated on July 27, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.