Individual provider Active NPI

Schani Manungo, NP-C

  • Family Nurse Practitioner
  • Indianapolis, IN
National Provider Identifier
1104175470
Registry record updated Mar 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71004160A Issued in IN
Practice address
3881 Eagle Creek Pkwy Ste a
Indianapolis, IN 46254-5600
Phone
(317) 969-8332
Fax
(317) 969-8494
NPI assigned
Sep 2, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 71004160A IN
Family Nurse Practitioner 363LF0000X 71004160A IN Primary

Addresses

Primary practice location

3881 Eagle Creek Pkwy Ste a
Indianapolis, IN 46254-5600

Mailing address

3881 Eagle Creek Pkwy Ste a
Indianapolis, IN 46254-5600
Phone (317) 969-8332

Other names 1

  • Miss Schani Baptiste Former 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
I20130419000198 IN Practitioner - Nurse Practitioner 5991941874 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Indiana University School of Medicine, 2012
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

3881 Eagle Creek Pkwy
Suite a
Indianapolis, IN 46254-5600
Phone (317) 730-3956

Hospital & facility affiliations

  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
71004160AINMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ideal Health Clinic LLC Family CurrentSince Apr 12, 2023 Accepting new patients
Major Hospital Past Accepting new patients

Locations

3881 Eagle Creek Pkwy
Ste A
Indianapolis, IN 46254
Phone (317) 730-3956

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1346544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1104175470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3881 EAGLE CREEK PKWY STE A",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462545600",
            "telephone_number": "317-969-8332",
            "fax_number": "317-969-8494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3881 EAGLE CREEK PKWY STE A",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462545600",
            "telephone_number": "317-969-8332",
            "fax_number": "317-969-8494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANUNGO",
        "first_name": "SCHANI",
        "name_prefix": "Miss",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-02",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71004160A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71004160A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SCHANI",
            "last_name": "BAPTISTE",
            "prefix": "MISS",
            "credential": "NP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.