Mandy Jean Boeckman, FNP

Key facts

NPI

1124520069

Entity type

Individual (NPI type 1)

Primary specialty

Family Nurse Practitioner 363LF0000X

License

71007881A (IN)

Practice address

2796 W 500 S
Portland, IN 47371-7308

Phone

(260) 729-3523

Fax

(812) 220-4280

NPI assigned

Mar 7, 2018

Sex

Female

Sole proprietor

No

Organizations & group practices 3

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.

• Meridian Health Services Corp Mental Health Clinic/Center (Including Community Mental Health Center) · Muncie, IN · NPI 1992755490
  Medicare reassignment NPD IN
• Meridian Health Services Corp. Federally Qualified Health Center (FQHC) · Montpelier, IN · NPI 1417838574
  NPD
• Lima Memorial Joint Operating Company General Acute Care Hospital · Lima, OH · NPI 1336144732
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 8, 2025.

{
    "created_epoch": "1520380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744070400000",
    "number": "1124520069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2796 W 500 S",
            "city": "PORTLAND",
            "state": "IN",
            "postal_code": "473717308",
            "telephone_number": "260-729-3523",
            "fax_number": "812-220-4280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2796 W 500 S",
            "city": "PORTLAND",
            "state": "IN",
            "postal_code": "473717308",
            "telephone_number": "260-729-3523",
            "fax_number": "812-220-4280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOECKMAN",
        "first_name": "MANDY",
        "middle_name": "JEAN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-07",
        "last_updated": "2025-04-08",
        "certification_date": "2025-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71007881A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "28209065A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Taylor Brackman, DC
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All providers in Portland, IN · Family Nurse Practitioner in Indiana