Individual provider Active NPI

Monicah Kariuki, NP

  • Nurse Practitioner
  • Fort Wayne, IN
National Provider Identifier
1083205496
Registry record updated Jun 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
71011109A Issued in IN
Practice address
7836 W Jefferson Blvd Ste 101
Fort Wayne, IN 46804-4178
Phone
(260) 494-3484
NPI assigned
Jan 28, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 000000000000 IN
Nurse Practitioner 363L00000X APRN.CNP.0031428 OH
Nurse Practitioner 363L00000X 71011109A IN Primary

Addresses

Primary practice location

7836 W Jefferson Blvd Ste 101
Fort Wayne, IN 46804-4178

Mailing address

120 W 22ND St Ste 200
Oak Brook, IL 60523-1563
Phone (630) 573-5000

Other practice location 1

1950 Ridgedale Rd
South Bend, IN 46614-2243
Phone (574) 291-6722

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address credentialing@nephdocs.com Direct

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
I20210602002019 IN Practitioner - Nurse Practitioner 4789083395

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
000000000000INMDNurse Practitioner
71011109AINMDNurse Practitioner
APRN.CNP.0031428OHMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fort Wayne Vascular Care LLC CurrentSince Jul 19, 2021 Accepting new patients

Locations

120 W 22nd St
Ste 200
Oak Brook, IL 60523
Phone (630) 575-5000

1833 Magnavox Way
#100
Fort Wayne, IN 46804
Phone (260) 918-0997

1833 Magnavox Way
Fort Wayne, IN 46804
Phone (260) 432-1036

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.

NPI Registry JSON

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

{
    "created_epoch": "1611792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655164800000",
    "number": "1083205496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 W 22ND ST STE 200",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231563",
            "telephone_number": "630-573-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7836 W JEFFERSON BLVD STE 101",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044178",
            "telephone_number": "260-494-3484"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1950 Ridgedale Rd",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466142243",
            "country_code": "US",
            "telephone_number": "574-291-6722",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KARIUKI",
        "first_name": "MONICAH",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-28",
        "last_updated": "2022-06-14",
        "certification_date": "2021-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "000000000000",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "APRN.CNP.0031428",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71011109A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "credentialing@nephdocs.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "7836 W Jefferson Blvd Ste 101",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468044178",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.