Active NPI
Christine Elizabeth Coulter, MSN, FNP
- Family Nurse Practitioner
- South Bend, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 71002742A
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200922290 | Medicaid | IN | |
| 178420KK | Other | IN | MEDICARE 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
Enrollment records 1
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
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
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Healthlinc, Inc. | Current | Accepting new patients | |
| Primary Care Partners of South Bend | Family | Current | Accepting new patients |
| Healthlinc, Inc | Current | 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
- https://api.platform.athenahealth.com/20750/brand/1/csg/1/fhir/r4
- 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.
-
- Family Medicine Physician
- South Bend, IN
- NPI 1497399927
-
- Federally Qualified Health Center (FQHC)
- Valparaiso, IN
- NPI 1528262581
-
- Federally Qualified Health Center (FQHC)
- Morocco, IN
- NPI 1568354116
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- South Bend, IN
- NPI 1295772093
-
- Psychiatric Hospital Unit
- South Bend, IN
- NPI 1376841395
-
- General Acute Care Hospital
- Granger, IN
- NPI 1881177756
-
- General Acute Care Hospital
- Mishawaka, IN
- NPI 1023965795
-
- General Acute Care Hospital
- Mishawaka, IN
- NPI 1841245594
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.