Individual provider Active NPI

Matthew McCracken

  • Gerontology Nurse Practitioner
  • Indianapolis, IN
National Provider Identifier
1104579770
Registry record updated Oct 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
71012225A Issued in IN
Practice address
8111 S Emerson Ave FL 5
Indianapolis, IN 46237-8601
Phone
(317) 528-6298
Fax
(317) 528-8532
NPI assigned
Feb 2, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2023

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 71012225A IN Primary
Nurse Practitioner 363L00000X 28157506A IN

Addresses

Primary practice location

8111 S Emerson Ave FL 5
Indianapolis, IN 46237-8601

Mailing address

PO Box 781076
Detroit, MI 48278-1076
Phone (317) 528-4800

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
I20220408001306 IN Practitioner - Nurse Practitioner 8628464179 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Franciscan Physician NetworkGroup PAC ID 3072790682, 1,152 clinicians

Practice addresses (Care Compare)

8111 S Emerson Ave
Palliative Care Dept 5TH Floor
Indianapolis, IN 46237-8601
Phone (317) 528-8930

Hospital & facility affiliations

  • Franciscan Health Indianapolis Hospital, Indianapolis, IN, CCN 150162

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28157506AINMDNurse Practitioner
71012225AINMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Physician Network CurrentSince Apr 24, 2022 Accepting new patients
Franciscan Physician Network CurrentSince Apr 24, 2022 Accepting new patients

Locations

1704 Lafayette Rd
Ste 4
Crawfordsvlle, IN 47933
Phone (765) 364-3120

1040 Sierra Dr
Ste 400
Greenwood, IN 46143
Phone (317) 528-4886

8111 S Emerson Ave
Fl 5
Indianapolis, IN 46237
Phone (317) 528-6298

150 W Washington St
Shelbyville, IN 46176
Phone (317) 392-3211

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": "1643760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696982400000",
    "number": "1104579770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 781076",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482781076",
            "telephone_number": "317-528-4800",
            "fax_number": "317-865-1479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8111 S EMERSON AVE FL 5",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462378601",
            "telephone_number": "317-528-6298",
            "fax_number": "317-528-8532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCRACKEN",
        "first_name": "MATTHEW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-02-02",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IN",
            "license": "71012225A",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "28157506A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.