Individual provider Active NPI

Lensa Gideon Girsha, BSN, MS, APN

  • Adult Health Nurse Practitioner
  • Bremen, IN
National Provider Identifier
1013242080
Registry record updated Jun 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
28163955A Issued in IN
Practice address
417 S Whitlock St
Bremen, IN 46506-1626
Phone
(574) 546-3730
NPI assigned
Oct 8, 2009
Last updated
Jun 4, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 28163955A IN Primary

Addresses

Primary practice location

417 S Whitlock St
Bremen, IN 46506-1626

Mailing address

707 E Cedar St
Ste 200
South Bend, IN 46617-2057
Phone (574) 335-8707

Other identifiers 1

IdentifierTypeStateIssuer
201253250MedicaidIN

Other names 1

  • Lensa Gideon Girsha Other name

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
I20141119001367 IN Practitioner - Nurse Practitioner 6204058647 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor on Science - Nursing, Master of Science, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
28163955AINMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Aims, LLC CurrentSince Jan 23, 2019 Accepting new patients
Saint Joseph Regional Medical Center, Inc. Past Accepting new patients

Locations

417 S Whitlock St
Bremen, IN 46506
Phone (574) 546-0330

1625 E Jefferson Blvd
Mishawaka, IN 46545
Phone (219) 257-2295

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.

NPI Registry JSON

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

{
    "created_epoch": "1254960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591228800000",
    "number": "1013242080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 E CEDAR ST",
            "address_2": "STE 200",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172057",
            "telephone_number": "574-335-8707",
            "fax_number": "574-335-0750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 S WHITLOCK ST",
            "city": "BREMEN",
            "state": "IN",
            "postal_code": "465061626",
            "telephone_number": "574-546-3730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIRSHA",
        "first_name": "LENSA",
        "middle_name": "GIDEON",
        "name_prefix": "Mrs.",
        "credential": "BSN, MS, APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-08",
        "last_updated": "2020-06-04",
        "certification_date": "2020-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IN",
            "license": "28163955A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201253250",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LENSA",
            "last_name": "GIRSHA",
            "middle_name": "GIDEON",
            "credential": "BSN, MS, APN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bremen, IN

Sources for this page

Verify at the official NPI Registry.