Jacob C Shively

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

71012742A Issued in IN

Practice address

11104 Parkview Circle Dr Ste 330
Fort Wayne, IN 46845-1674

Phone

(260) 494-3484

Fax

(260) 969-0188

NPI assigned

Apr 28, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 4

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

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Nephrology Associates of Northern Indiana PCGroup PAC ID 8921033440, 64 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Parkview Regional Medical Center Hospital, Fort Wayne, IN, CCN 150021
• Lutheran Hospital of Indiana Hospital, Fort Wayne, IN, CCN 150017
• Parkview Noble Hospital Hospital, Kendallville, IN, CCN 150146
• Parkview Huntington Hospital Hospital, Huntington, IN, CCN 150091
• Parkview Whitley Hospital Hospital, Columbia City, IN, CCN 150101

Merit-based Incentive Payment System (MIPS)

Final score

83.53 of 100Reported as group

Quality

70

Promoting interoperability

100

Improvement activities

40

Cost

75.11

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jshively60561@direct.acumenmd.com
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: jshively223568@direct.parkviewexchange.com

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.

• Nephrology Associates of Northern Indiana, Inc

  • Nephrology Physician
  • Fort Wayne, IN
  • NPI 1578505814
  Medicare reassignment Care Compare group NPD
• Parkview Health System Inc

  • Family Medicine Physician
  • Fort Wayne, IN
  • NPI 1932130952

  Nurse Practitioner

  Medicare reassignment NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Community Hospital of Noble County, Inc.

  • General Acute Care Hospital
  • Kendallville, IN
  • NPI 1457366189
  Care Compare affiliation
• Huntington Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Huntington, IN
  • NPI 1003821729
  Care Compare affiliation
• Iom Health System LP

  • General Acute Care Hospital
  • Fort Wayne, IN
  • NPI 1306897335
  Care Compare affiliation
• Parkview Hospital, Inc.

  • General Acute Care Hospital
  • Fort Wayne, IN
  • NPI 1366407603
  Care Compare affiliation
• Whitley Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Columbia City, IN
  • NPI 1205844495
  Care Compare affiliation
• Whitley Memorial Hospital, Inc.

  • Land Ambulance
  • Columbia City, IN
  • NPI 1497764450

  Hospital

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1651104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698796800000",
    "number": "1215672928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 W 22ND ST STE 200",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231563",
            "telephone_number": "630-573-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11104 PARKVIEW CIRCLE DR STE 330",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451674",
            "telephone_number": "260-494-3484",
            "fax_number": "260-969-0188"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11104 Parkview Circle Dr Ste 110",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468451673",
            "country_code": "US",
            "telephone_number": "260-425-6780",
            "fax_number": "260-425-6789",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIVELY",
        "first_name": "JACOB",
        "middle_name": "C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-28",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71012742A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jshively223568@Direct.Parkviewexchange.com",
            "affiliation": "N",
            "address_1": "11104 Parkview Circle Dr Ste 110",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451673",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "11104 Parkview Circle Dr Ste 110",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451673",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "11104 Parkview Circle Dr Ste 110",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451673",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "credentialing@nephdocs.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "120 W 22nd St Ste 200",
            "city": "Oak Brook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605231563",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amruta Shirbhate
• Michael A Shirley, MD
• Narine Shirvanian, DO
• Brooke Shively
• Gail L Shively, NP
• Kristina Shively, LPN
• Monica Shively, LPN
• Sonya Ann Shively, DDS
• Susan Shively, LMT
• Shock Therapy Group LLC

• Nurse Practitioner in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2023; 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.

Verify at the official NPI Registry.