NPIMap

Individual provider Active NPI

Selena Joyce Roggeveen, NP

  • Family Nurse Practitioner
  • Crown Point, IN
National Provider Identifier
1134993041
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71014849A Issued in IN
Practice address
11161 Randolph St
Crown Point, IN 46307-8564
Phone
(219) 662-9424
Fax
(219) 662-7465
NPI assigned
Nov 10, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 28161718A IN
Family Nurse Practitioner 363LF0000X 71014849A IN Primary

Addresses

Primary practice location

11161 Randolph St
Crown Point, IN 46307-8564

Mailing address

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

Other practice location 1

8135 Calumet Ave
Munster, IN 46321-1701
Phone (219) 513-2000

Other names 1

  • Selena Joyce Wood Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240118001788 IN Practitioner - Nurse Practitioner 1557713260 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Franciscan Physician NetworkGroup PAC ID 3072790682, 1,152 clinicians

Practice addresses (Care Compare)

11161 Randolph St
Crown Point, IN 46307-8564
Phone (219) 662-9424

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28161718AINMDRegistered Nurse
71014849AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Physician Network CurrentSince Aug 25, 2024 Accepting new patients
Nwi Urgent Care, LLC CurrentSince Dec 12, 2023 Accepting new patients
Franciscan Physician Network CurrentSince Aug 25, 2024 Accepting new patients
The Methodist Hospitals, Inc PastSince Nov 1, 2023 Accepting new patients

Locations

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

11161 Randolph St
Crown Point, IN 46307
Phone (219) 662-9424

31 Sibley St
Ste A
Hammond, IN 46320
Phone (219) 802-8800

8135 Calumet Ave
Munster, IN 46321
Phone (219) 513-2000

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

Organizations & group practices 6

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 10

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": "1699574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722816000000",
    "number": "1134993041",
    "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": "11161 RANDOLPH ST",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463078564",
            "telephone_number": "219-662-9424",
            "fax_number": "219-662-7465"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8135 Calumet Ave",
            "address_purpose": "LOCATION",
            "city": "Munster",
            "state": "IN",
            "postal_code": "463211701",
            "country_code": "US",
            "telephone_number": "219-513-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROGGEVEEN",
        "first_name": "SELENA",
        "middle_name": "JOYCE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-10",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28161718A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71014849A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SELENA",
            "last_name": "WOOD",
            "middle_name": "JOYCE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Crown Point, IN

Sources for this page

Verify at the official NPI Registry.