Individual provider Active NPI

Melisa Kaye Renner, APRN, MSN, FNP-C

  • Family Nurse Practitioner
  • Fort Wayne, IN
National Provider Identifier
1043494503
Registry record updated Apr 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71010644A Issued in IN
Practice address
6326 Constitution Dr
Fort Wayne, IN 46804-1518
Phone
(260) 515-3275
NPI assigned
Dec 19, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71010644A IN Primary

Addresses

Primary practice location

6326 Constitution Dr
Fort Wayne, IN 46804-1518

Mailing address

6326 Constitution Dr
Fort Wayne, IN 46804-1518
Phone (260) 515-3275

Other identifiers 1

IdentifierTypeStateIssuer
300047110MedicaidIN

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
I20210126003259 IN Practitioner - Nurse Practitioner 2668886086 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
RP Care LLCGroup PAC ID 9234424813, 31 clinicians

Practice addresses (Care Compare)

6326 Constitution Dr
Fort Wayne, IN 46804-1518
Phone (260) 515-3275

Hospital & facility affiliations

  • Adams Memorial Hospital Hospital, Decatur, IN, CCN 151330
  • Parkview Wabash Hospital, Inc Hospital, Wabash, IN, CCN 151310
  • Parkview Regional Medical Center Hospital, Fort Wayne, IN, CCN 150021

Merit-based Incentive Payment System (MIPS)

Final score
19.81 of 100Reported as individual
Quality
0
Promoting interoperability
0
Improvement activities
0
Cost
66.05

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing

State licenses

LicenseStateTypeSpecialty
71010644AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
RP Care LLC Family CurrentSince Jan 1, 2021 Accepting new patients

Locations

6326 Constitution Dr
Fort Wayne, IN 46804
Phone (260) 515-3275

Organizations & group practices 1

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.

Hospital & facility affiliations 3

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": "1198022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617235200000",
    "number": "1043494503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6326 CONSTITUTION DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468041518",
            "telephone_number": "260-515-3275",
            "fax_number": "888-803-6843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6326 CONSTITUTION DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468041518",
            "telephone_number": "260-515-3275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENNER",
        "first_name": "MELISA",
        "middle_name": "KAYE",
        "credential": "APRN, MSN, FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-12-19",
        "last_updated": "2021-04-01",
        "certification_date": "2021-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71010644A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300047110",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.