NPIMap

Individual provider Active NPI

Gina M. Connolly, NP

  • Adult Health Nurse Practitioner
  • Chesterton, IN
National Provider Identifier
1023364262
Registry record updated May 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
71004080A Issued in IN
Practice address
738 E Oak Hill Rd
Chesterton, IN 46304-1360
Phone
(317) 672-5226
Fax
(574) 237-6069
NPI assigned
Jul 25, 2012
Last updated
May 6, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 71004080A IN
Adult Health Nurse Practitioner 363LA2200X 71004080A IN Primary

Addresses

Primary practice location

738 E Oak Hill Rd
Chesterton, IN 46304-1360

Mailing address

710 N Niles Ave
South Bend, IN 46617-1924
Phone (574) 647-1610

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address gconnolly@mybeacon.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121012000774 IN Practitioner - Nurse Practitioner 2365691037 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Beacon Medical Group IncGroup PAC ID 1254243306, 575 clinicians

Practice addresses (Care Compare)

611 E Douglas Rd
Mishawaka, IN 46545-1465
Phone (574) 232-7227

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
71004080AINMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group, Inc. Current Accepting new patients
Beacon Medical Group Inc CurrentSince Jan 1, 2019 Accepting new patients
Beacon Medical Group, Inc. CurrentSince Jan 1, 2019 Accepting new patients
Major Hospital Past Accepting new patients
Beacon Medical Group, Inc. Past Accepting new patients

Locations

900 I St
Laporte, IN 46350
Phone (219) 324-1670

611 E Douglas Rd
Ste 207
Mishawaka, IN 46545
Phone (574) 232-7227

100 Navarre Pl
Ste 6600
South Bend, IN 46601
Phone (574) 232-7227

710 N Niles Ave
South Bend, IN 46617
Phone (574) 647-1610

Interoperability endpoints

  • Direct secure messaging: gconnolly@mybeacon.cernerdirect.com
  • Direct secure messaging: gconnolly434949@direct.franciscanalliance.org

Organizations & group practices 5

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 6

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": "1343174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778025600000",
    "number": "1023364262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 N NILES AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171924",
            "telephone_number": "574-647-1610",
            "fax_number": "574-237-6069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "738 E OAK HILL RD",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463041360",
            "telephone_number": "317-672-5226",
            "fax_number": "574-237-6069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOLLY",
        "first_name": "GINA",
        "middle_name": "M.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-25",
        "last_updated": "2026-05-06",
        "certification_date": "2026-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IN",
            "license": "71004080A",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IN",
            "license": "71004080A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gconnolly@mybeacon.cernerdirect.com",
            "affiliation": "N",
            "address_1": "100 Navarre Pl Ste 6600",
            "city": "South Bend",
            "state": "IN",
            "country_code": "US",
            "postal_code": "466011173",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chesterton, IN

Sources for this page

Verify at the official NPI Registry.