Individual provider Active NPI

Christine Elizabeth Coulter, MSN, FNP

  • Family Nurse Practitioner
  • South Bend, IN
National Provider Identifier
1144479460
Registry record updated Jan 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71002742A Issued in IN
Practice address
621 Memorial Dr Ste 402
South Bend, IN 46601-1074
Phone
(574) 400-4550
Fax
(574) 400-4551
NPI assigned
Sep 10, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71002742A IN Primary

Addresses

Primary practice location

621 Memorial Dr Ste 402
South Bend, IN 46601-1074

Mailing address

710 N Niles Ave
South Bend, IN 46617-1924
Phone (574) 647-1610

Other identifiers 2

IdentifierTypeStateIssuer
200922290MedicaidIN
178420KKOtherINMEDICARE PTAN

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
I20081212000511 IN Practitioner - Nurse Practitioner 2567478175 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Primary Care Partners of South BendGroup PAC ID 7810319712, 4 clinicians

Practice addresses (Care Compare)

300 S Saint Louis Blvd
Suite 204
South Bend, IN 46617-3044
Phone (574) 251-1200

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Healthlinc, Inc. CurrentSince Nov 1, 2018 Accepting new patients
Primary Care Partners of South Bend Family CurrentSince Jul 1, 2020 Accepting new patients
Healthlinc, Inc CurrentSince Nov 1, 2018 Accepting new patients

Locations

621 Memorial Dr
Ste 402
South Bend, IN 46601
Phone (574) 232-4800

1708 High St
South Bend, IN 46613
Phone (574) 237-6640

300 S Saint Louis Blvd
Ste 204
South Bend, IN 46617
Phone (574) 251-1200

2401 Valley Dr
Valparaiso, IN 46383
Phone (219) 413-5100

1001 Sturdy Rd
Valparaiso, IN 46383
Phone (219) 462-7173

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/20750/brand/1/csg/1/fhir/r4
  • Direct secure messaging: christine.coulter.1@20750.direct.athenahealth.com

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.

Hospital & facility affiliations 5

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": "1221004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548720000000",
    "number": "1144479460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 N NILES AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171924",
            "telephone_number": "574-647-1610",
            "fax_number": "574-237-6069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 MEMORIAL DR STE 402",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011074",
            "telephone_number": "574-400-4550",
            "fax_number": "574-400-4551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COULTER",
        "first_name": "CHRISTINE",
        "middle_name": "ELIZABETH",
        "credential": "MSN, FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-10",
        "last_updated": "2019-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71002742A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200922290",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "178420KK",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.